Good morning, good afternoon, and good evening, everyone. My name is Romina Valadez, and I am the International Relations Manager at ASPS. Welcome to the ASPS Global Partner Webinar Series. Today's webinar has very good topics with great speakers and moderator from Italy and Germany. Before we get started, I would like to talk to you about ASPS. On behalf of the entire ASPS leadership, we thank you for your participation. ASPS is the largest plastic surgery organization in the world with over 12,000 members and subscribers, including plastic surgeons, residents, medical students, and other members categories. ASPS provides lots of opportunities for members to become and remain engaged with the society. During this past year, 1,450 ASPS members volunteered their time, energy, and talent to serve on our 74 committees and task forces. We currently have 50 global partners at ASPS, including Canada. The International Visiting Professors Programs conducts virtual visits to international plastic surgery institutions. International Residence Forum offer opportunities to contribute to ongoing projects and develop new projects specific to residency training and beyond. In addition to research grants, the Plastic Surgery Foundation also includes innovative global health initiative through our volunteers in plastic surgery and share. And share. GAPS is the new PSF pilot program to build international union and foster exchange between U.S. and global partners training programs. The Plastic Surgery Foundation peers U.S. programs with overseas academic programs and share the cost of travel. The Plastic Surgery Education Network, known as the ASPS EdNet, is the online learning center developed by the American Society of Plastic Surgeons with cooperation of several plastic surgery subspecialty societies. EdNet offers fresh content in all areas of plastic surgery every month. The ASPS Education Network offers more than 90 self-assessment models for practicing surgeons and residents. Each model provides journals, article readings, presentations, videos, and tests that covers all aspects of the specialty. Program directors are welcome to enroll their residents in the ASPS Education Network, REC, and review transcripts to track progress. This slide shows a few highlights of the PRS journal that is included with your subscription. And this is the PRS Global Open, which is also included with your subscription. On the screen are some of the benefits of international membership in ASPS. As our international membership continues to grow, so do our offering to the global community. We had a very successful annual meeting in Austin last October, and we are looking to build on that in San Diego this year. We hope you can all attend Plastic Surgery, the meeting in late September. And the 2024 ASPS Spring Meeting returned in a virtual format in March on the 1st through the 3rd with more outstanding education. This all will be available online. International resident subscribers of ASPS can register to this ASPS Spring Meeting for free before February 16. There are so many benefits to membership in ASPS for our international colleagues, including a subscription to PRS journal and member discount to Plastic Surgery, the meeting. To join the society, we have QR codes with discounts for residents and practicing plastic surgeons on the screen. I would like to introduce our moderator today, Dr. Estefania Difasio from Italy. Dr. Difasio is a board certified plastic and cosmetic surgeon. She's the current president of CICPRED, the Italian Society of Plastic Reconstructive, Regenerative and Aesthetic Society. She's also the international liaison to ASPS, IcePress, Icopress, ISAPS and AMWC. And she's also the secretary of the IcePress, International Society of Plastic Regenerative Surgeons. Thank you. Thank you. Thank you, Romina. And thank you, everybody. Romina, she is the soul of the global registry forum. And I thank you for showing the amazing benefits that come from joining ASPS, like an international member or the resident. So let's go with this excellent webinar. And don't forget to submit questions. Please submit your question throughout the presentation using the Q&A features at the bottom of your screen. We will answer as many questions as possible at the end of each presentation during the webinar. After each presentation, only five minutes are dedicated to Q&A. And please note that today's webinar will be recorded and posted to ASPS e-net for ASPS members. If you are not an ASPS members and you wish to become one, please connect with Romina Valadez to the email address that you are seeing on the screen. I'm very glad to moderate this webinar that's featuring Italy and Germany. We have the first presenter, Stefania Tenna. She's a board certified plastic surgeon, PhD and Evopress. She's an associate professor of the plastic surgery department of Campus Biomedical University in Rome. And she's starting the webinar with her presentation. The title is Integrated Care Pathway for Advanced Skin Cancer, the Key Role of Plastic Surgeons. Then we have Alessandra Veronese. She is a board certified plastic surgeon, assistant to the surgical unit of plastic surgery at the Humanities Institute in Milan. The title of the presentation is Secondary Breast Prosthetic Surgery, the Six Winning Moves. And then last but not least, we have Riccardo Giunta. He's a chief director of the department of plastic surgery of the Ludwig Maximilian University founded in Monaco in 1472. He is the past president of the German Society of Plastic Reconstructive and Aesthetic Surgery. Naturally, he is the president of the Ispress Surgery, the European Society of Plastic Reconstructive and Aesthetic Surgery. And the title of his presentation is Continuing Education in Plastic Surgery in Europe and its relevance for patient's safety. So we can start with the first presentation and please, Stefania, the screen is yours. Thank you, Stefania. And good afternoon and good evening, everyone. It's a real pleasure for me to be here also because United States have been a part of my professional life and thanks to my mentor, Professor Brian Tautz. I had a fellowship with him in San Francisco many, many years ago. And so it's really an honor for me to present my work to all of you tonight. The topic of my talk is about the skin cancer management. Skin cancer is really a public health problem. And there are many different subtypes. We have melanoma and non-melanoma skin cancer. And according to guidelines, the primary treatment of skin cancer is surgical. And so being a plastic surgeon, all of us are quite used to remove skin cancer and to reconstruct, to repair and restore the effect applying all the procedure that being a specialist that we know from the simple to the most, sorry, to the most difficult. And here you can see many contribution. These are some from my group, from my university, but of course in literature, you can find a lot. And there are lots of different techniques that are quite used for plastic surgeon. This is a frontal flap to repair the effect of the nose. And these are perforated flaps in a propeller fashion for a skin cancer of the limb. That's of course all plastic surgeon are quite used to perform. But what is the issue when skin cancer present in advanced stages? Especially after the pandemic, we have found out very severe cases presenting with, especially in fragile patients with comorbidities and all patients with age more than 75 years. So in this case, it's guidelines again, suggest that the surgery may be not the first treatment, but maybe you can switch to different therapies like radiotherapy or systemic therapy as all of you knows, there are lots of different new and old medicine that can be applied. Target therapy for the edge signal inhibitor for basal cell carcinoma or the immune checkpoint inhibitors for squamous cell carcinoma. And for melanoma, we have the target therapy or immunotherapy and radiotherapy, electrochemotherapy for metastasis and so on. So when an advanced case presents with severe aggressive disease, what is the best things to do? And most of all, who and how is gonna make a decision? Since 2019 in my university, we have been create a multidisciplinary team that for me is the key how to address all cancer now. And as you can see, we have lots of specialists. The core of this meeting that we have once a week are with plastic surgeon, dermatologist, oncologist, radiotherapist, pathologist. And we discuss all the cases you see, T3, T4, distant met and fragile patient and so on. What is the core of the discussion now? Is first of all, you have to decide whether surgery is feasible or not. And then you have to discuss whether other approach are advantages or not, or if the patient has to go for palliative care. We have been discussing more than 350 patients and this is our decision-making algorithm. I'm not gonna read it. It's too long and a little bit articulated, but just to tell you that in my group, surgery is still the primary treatment that we offer to patients because surgery is the treatment, the gold standard for skin cancer. So the issue, the question is what is resectable and what is un-resectable and who is gonna make the difference? Plastic surgeon should rule the process. In my group, as you can see, the majority of patient, even if old, even if with comorbidities, have underwent surgery as a primary treatment, also with complex procedure. Being a plastic surgeon, we have to offer to our patients all the possibility to repair and restore even very wide defect, very deep, because we can transfer many tissue and we can switch to procedure difference. And that's the key to resect sometimes very big tumor. So let's go through our strategy. Of course, you need to have a dedicated team and to have a dedicated team is not only a question of surgeon, but most of all is also a question of anesthesiologist. Your anesthesiologist should be used to local regional blocks, pain control, because sometimes patients need to perform surgery under local anesthesia, even if is big surgery. And for us, for the reconstruction, especially if you have to go to microsurgical reconstruction, you need to change your way of making the strategy. I mean that, of course, when you plan a big reconstruction, you go through the flap choice. And you, all of us knows that you try to choose the best flap in terms of versatility, volume, renovation, donor sites, that's a kind of dissection. And again, these just to show are just the least of flaps that more frequently are used for cancer management and reconstruction. Of course, you need to choose the proper recipient vessels, but in those patients is crucial that the choice should depend on the patient position in the operating theater, the possibility to have two teams working at the same time in order to shorten the operating time. And so location of the defect, dimension of the defect that are secondary in choosing the best kind of flaps. So briefly, I want to show you some of our cases just to show how we do the decision-making process. This is an old man, 85 years old, recurrent squamous cell carcinoma of the scalp, infiltration of the bone. And so the discussion and the strategy is, of course, resection with craniotomy together also with a neurosurgeon and then reconstruction with a latissimus dorsi muscle-free flap and skin graft. And you can see the anastomosis on the temporalis fascia. And this is the follow-up at three years free of disease. Different case, 80 years old woman. In a way, less comorbidity, but major depressive disorder, and most of all, distant maths. She hadn't had a therapy before, but she came for some bleeding and also for difficult support from the caregivers. And so the decision in this situation was not to go for a bigger operation, but just to reduce the tumor, control the bleeding, and then go on with palliative care. Difficult cases are also those that are not responsive to therapies. Sometimes it happens that even a young patient like this one starts treatment with other therapies. And this, unfortunately, it happens when those severe cases are not referred to centers, to major center, and maybe some oncologists start the therapy and then the patient has a delay in what would have been probably a good first surgical approach. You can see here a latissimus dorsi flap again, but unfortunately the patient was lost at follow-up. Resectable or unresectable? Of course, these cases look very difficult. But again, with local regional blocks, they are resectable in specialized teams. As you can see here, we have performed an anterolateral flap with a double skin paddle in order to reconstruct both the cheek and the lower lip. And this is another case, a young man, but very severe recurrence of squamous cell carcinoma. And again, major resection and reconstruction with microsurgical free flap. Sometimes those extreme surgery and the integrated care pathway need also bioethic consultation, like in these cases, when really surgery is more palliative than everything. But you need to improve somehow the quality also of the assistance. And this was one of the worst cases we have done in the last four years after the pandemic. and it was really a pain for all of us that despite all the efforts the patient unfortunately passed away after 15 days. But just going to the conclusion of my talk, I want to show you also cases like this that again in other institutions has been considered sometimes very difficult to respect and on the contrary if plastic surgeons offer their skills doing a big reconstruction that also could may require multiple steps like in this case because we have the first operation to rebuild all the lower lip also using the palmaris tendon to the commissura and then of course the patient goes on with some touch up in order to for the debulking of the flap and other improvement to restore the function. So what I want to tell you has a take-home message. Integrated care pathway in our experience are really a precious tool to manage complex situation and plastic surgeon should rule the strategy in the management of skin cancer. So I would like to transmit that also guidelines which are of course the base for every strategy should be discussed in reference center where all the specialists are used to all the approach and surgery is not dismissed because seems not easy to do. This is a teamwork and believe me is a pleasure to share with all my colleagues this journey that always every day give us lots of satisfaction and also fun and I want to thank you very much for your attention. I'm ready for all your questions. Thank you. Stephanie, thank you very much. Very impressive cases. Amazing and yes the secret of the success is also an excellent teamwork and we have a question for you. We don't have a lot of time but we have a question for you. In the term of evidence-based medicine is this approach confirmed to be the most suitable, the most appropriated, best one? Tell me Stephanie. Thank you Stefania. Thank you for your question. You were right. I mean I mean integrated care pathway are I believe quite used in lots of our country. I'm pretty sure also in Germany, in United States but these are in a way recent. I mean there is not as much in literature also because it's not easy to demonstrate that this kind of approach is really more efficient. I do hope, I am sure that in the future we will have more papers that will measure the benefits to approach those cases in an integrated way but up until now you are right and from the evidence-based medicine point of view we don't have the support of many papers telling us that this is absolutely better than going on with just guidelines without discussing. So this is, I think this is a lot, a lock that we have to fill. Probably with studies. Yes we need to publish more and to be more focused on publishing guidelines on this topic. So thank you very much Stefania and we move to the next presenter Alessandra Veronese. Thank you Stefania. Thank you very much. Thank you. Thank you again and Alessandra the screen is yours. Thank you. Thank you very much Stefania. Hi to everybody, good afternoon and good evening and it's an honor for me to be here, to be here tonight to talk with you about what are in our opinion the sixth winning moves in secondary breast prosthetic surgery. Prosthetic surgery is worldwide known as the procedure with the highest re-operation rate and this re-operation rate is estimated in 25 percent in cosmetic surgery and about in 42-45 percent in reconstruction. The most common request of our patient, I'm sorry but I can't, okay okay, the request is to have a natural breast shape, the softness of the breast and a correct position of the nipple areolar complex in the central maximal projection of the cone. Another request of the patient is a breast with no visibility of the implant with a good tissue covering and a minimal scar. So in our practice we selected the six options of surgical technique that we call the winning moves that allow us to obtain the best result. This kind of technical approach are mixing together to obtain best results. In particular we perform capsulotomy and capsulography to release capsular contraction or to reshape and redefine the pocket in all the cases that we treat and it allows us to correct a superior or inferior prosthetic displacement and correct convexity and concavity of the breast. In some cases, capsulotomy and capsulography are mandatory and it allows us to perform also capsular frappe like a source of well vascularized and healthy tissue to correct the profile of our breast. Every time during the surgical maneuver we are going to expose the prosthesis, we have to change the implant and sometimes we have also to change the plan in which we will put the prosthesis from sub-glandular to sub-muscular or from sub-muscular to retro-glandular for more natural result and the reshaping of the pocket. Often we have to choose different implants with the different width, different height and different projection and also with different cohesivity of the gel. In our portfolio we have a lot of kind of prosthesis, round, anatomical, more projected with the high hyperprojection, eight and so on. Another goal is to obtain with minimal scar with periareolar maxopexy and nipple areal complex in the center of the breast and at the same time reduce the skin excess to reshape the gland. At the end but not as least option, we use often FET not only for partial volume augmentation but also for scar releasing, for lengthening retracted area, for release all the covering tissue and to reduce the retraction due to radiotherapy in reconstructive surgery. So let's see some of our case. In this case we have a secondary surgery, we see the lower displacement of the prosthesis in the right breast, we perform a capsulotomy, we perform a medial and lateral superior capsulotomy to obtain an enlargement of the breast, we change the implant and with the capsulography we redefine the shape of the breast and we reconstruct the inframammary fold. Another case with a change of plane of our prosthesis, we remove retroglandular prosthesis, we correct the wrinkling and the rippling of the breast and redefine the pocket going subpectoral. We use a smaller implant and in this case using also some fat in the medial upper pole of the breast, we redefine the pocket. Another case with the implant change, we perform a volume reduction, different prosthesis smaller in volume, the same plane, capsulotomy and capsulography and the repositioning of the neck in the center of the mouth. One difficult case in which pocket definition is the gold standard of our surgery, capsulotomy, capsulography, inframammary fold definition with stitches and the dressing that allows us to maintain the new pocket. You can see in this case the upper arm projection. This is another case, this is a reconstructed case, a nipple sparing mastectomy with the retromuscular implant, we change the implant, we redefine the pocket with the capsulotomy and the capsulography and the patient don't need a central centralization of the nipple area complex in the breast. A great degree of capsular contraction in a tuberous breast, the patient had previously retro glandular implants, we remove the implants, we harvested a retromuscular pocket and change the implant with the higher volume of implant. Another similar case with the change of plane from retroglandular to retromuscular and this is the final effect, the breast is more natural, is softer and it's not painful for the patient. In this case the problem is to correct the lower inframammary fold in right breast and try to have a symmetry with the other one breast. We remove retroglandular implant, we performed a periareal maxopexy but this was not sufficient to reduce the length of the lower pole of the breast and so we apply a vertical maxopexy to reduce the excess of skin. This is the same patient, we can see that we enlarge the volume of our prosthesis but the result is more natural and the breast is softer. Another case of breast reconstruction, a direct to implant reconstruction, the patient would like to improve the volume of the breast. We performed a capsulotomy in the left side and we performed a breast augmentation in the right side. With fat transplantation, we correct the thickness of the left breast. Another case of capsulotomy and change of implant with a more large implant. This is a really simple case and this is a case of a rupture of an implant. We perform the capsulotomy, capsulography, change of implant, periareal maxopexy, the three-quarter view and the profile view. When we talk about centralization of the nipolareolar complex on the top of the breast, we use frequently periareolar maxopexy but periareolar maxopexy is not only to consider as a concentric reduction of the skin. If we made an elliptical removal of the skin, we could reduce the length of the lower pole of the upper pole and make the breast more natural. This is an intraoperative view in which we show you that if we detach the gland from the major fascia and detach the skin from the gland, we can obtain a good maxopexy and a good result. In this case, capsulotomy is important to enlarge the lower pole to obtain a symmetrization of the breast. We remove the old implant and perform periareolar maxopexy, the three-quarter view and the profile view. Another beautiful case with this kind of result, capsulotomy, removal of implant and periareolar maxopexy. This is a case similar to the previous one, the same correction. This is a good result obtained with FET, needle and capsulotomy. You can see the three-quarter and the profile view. I go fast because the time is finishing. A kind of reconstructive surgery, latissimus dorsi pedicled flap with capsular contracture, capsulotomy, capsulography, periareolar maxopexy on the other side and FET for releasing scar. The last three cases, this patient underwent two bilateral mastectomy, a reconstruction with pre-pectoral prosthesis, de-evolution after five years, a rotation of the left breast. The patient would like to have no visibility of implant and she wants to reduce the volume. So this is an early result. We performed a change of plane from subcutaneous to sub-pectoral, capsulography and change of implant with the smaller one. Another particular case, an explantation in aesthetic surgery for an infection, the patient would like to maintain a large volume of her breast, so we apply a concept in aesthetic surgery derived from reconstruction surgery. We put an expander, we perform our expansion, we change the expanders with the definitive prosthesis and we use a needle for release the scars and fat. This case is still in progress and she needs of course of other fat injections. And to finish the last case, the patient underwent to our visit after a great quadrantectomy, she received radiotherapy, she would like to have a reconstruction but she didn't want a two-stage reconstruction, so we performed our first stage with positioning of a definitive implant and then with four sessions of fat injection and releasing of the scar with the needle, obtain this kind of result. So, in conclusion, the six moves that we observed, if correctly studied and mixed, will hallow the 100 percent of improvement in all cases. Of course, these six moves can be mixed and have been chosen in the correct way and applied together. Thank you very much. Thank you, Alessandra, thank you very much for your excellent presentation. You took some extra time, so I give you only one minute to reply to your question. I have a question for you. Do you use different approach in cosmetic surgery compared to reconstructive surgery? Oh, patients that underwent to a secondary breast reconstruction have high expectations, but the concept is the same. We have to observe the real needs of the breast of the patient. The patient in cosmetic surgery, we have more earthy tissues than in reconstruction, because in reconstruction we have more scars and more fixed tissues. The pectoral major muscle is not healthy like in cosmetic, but in our opinion, the maneuvers, the mix are choosing with the same sequence of, how can I say, the concept. We have to reshape the pocket and then we have to correct the tissues above the prosthesis. Alessandra, thank you very much, and we move to the last but not least presenters. Riccardo, welcome, and the screen is yours. Continuing education in plastic surgery in Europe and its relevance for patient safety. Thank you, Stefania, for your kind introduction and your invitation to this webinar. I'm very happy as a half German, half Italian to contribute to a German-Italian webinar, so that's a good thing to do. And in my current position as a president of the European Society for Plastic Surgery, with over 7,500 members in 40 countries, I'd like to lead you through an important hot topic which bothers many of the national societies. So, I think it's relevant for all of us and we have to do a conjoined effort to strengthen our specialty in the field against other specialties. So, when we look at our survey which we did in 2021, what are the hot topics in your national society in the European Leadership Forum, which is a platform where all the presidents of the national societies in Europe are united, aesthetic surgery performed by doctors who are not board-certified plastic surgeons was one of the hottest topics apart from many others, but this was definitely one of the hottest topics. And so, in the next years, we tried to do the best to strengthen our society and our plastic surgery specialty against others. So, let me first define the problem, what is really the problem and what is something which is also bothering patient safety. So, for example, here on the picture you see one of important aesthetic surgeon or well-known aesthetic surgeon in Germany, but in reality he's an ENT surgeon and he's been only trained in the face, of course, in ear, nose and throat. Nevertheless, he's acting as a plastic surgeon and also performing plastic surgery in aesthetic cases out of his region where he was trained. So, we have many certified surgeons of other disciplines who operate in officially untrained regions and nevertheless, there are also some specialties which do aesthetic surgery excellently. For example, in Germany for ENT, there is the subspecialty plastic surgery recognized with the curriculum and the final exam at the end and same is true for oral maxillofacial surgery. Nevertheless, many things happen and the most of us who lead big departments are also expert witnesses in cases at CURT and, for example, this is an internal medical doctor who does Brazilian butlists and in this case, in his private practice, two patients died. So, it's really an issue that we need people who are trained in difficult and not always easy cases and I think for the patient it's most important that the surgeon who he chooses has the best possible training. But it's not only non-surgeons who are doing plastic surgery, it's also non-specialists. So, in Germany, we have many just medical doctors who are calling themselves aesthetic surgeons without any surgical training and without having a final exam or an operative catalog. So, it's even done by paramedics in Germany and one of the key problems is that the term beauty surgeon is not protected by law in many countries. Let me show another case which was presented by Bob Murphy from the ASPS. This is a dentist who's doing nose operations and, of course, this is something we don't want and we want to avoid that severe complications are done when the patients are not aware that they are not operated by really trained plastic surgeons. So, this is the list more or less from all the stakeholders in plastic surgery and, of course, the board certified plastic surgeon has the highest degree of education. Terms like aesthetic surgeon, beauty doc, or cosmetic surgeon, beauty surgeon, unfortunately also used by our trained plastic surgeons, are not protected. So, just anybody can call themselves like this in many countries and this is very intransparent to the patients and we think that it's important that the patients are aware of this differentiation and this quality of training. So, the European society firstly evaluated the situation throughout Europe and, as previously mentioned, we have 40 countries. We did a survey in 23 of them, amongst them the biggest countries, how board certified plastic surgeons are trained in these countries and, for example, in Germany we have a six-year training program. We have a compulsory amount of operations in all regions of the body, not only in specific regions and the time and we also have time in other surgical specialties. So, people, the trainees, the residents have to go, for example, to the outpatient clinic, the emergency unit, and also to the intensive care unit to treat severely injured patients and to know out what to do in an emergency. At the end, there is a final exam and if they don't pass, they are not board certified plastic surgeons. So, it's a total of six years with a specific curriculum and a final exam in the end. This is the duration, of course, is one of the quality indicators and when we look through the countries, in Italy, for example, it's five years and in Spain it's the same, always with a core surgical training as a fundament and, for example, in the UK a foundation program of two years is additionally needed. So, the continuing education might last up to 10 years. When we look through Europe and this is a map of the participating country, you see that many countries participated. Most of the countries have a duration of more than five years, which is necessary in more than 80% of the countries. Only in smaller countries and with few plastic surgeons, the duration of the continuing education is less. The core surgical training in other disciplines like visceral surgery or trauma surgery is also relevant in 87% of the countries. So, it's also a fundament of a good quality education for a plastic surgeon who not only has to be educated in his specialty, but also needs to know how to treat, for example, emergencies in his private practice. For this reason, also the training in the surgical emergency department, most curriculums require this. In 98% of the countries this is true. So, most of the countries need a time, in Germany, for example, it's six months in a surgical emergency department. The same is, in my opinion, an intensive column of a good curriculum is the time at an intensive care unit and this is also required in 70% of the countries in Europe. Treatment of burn injuries, that's a very specific treatment, but still our specialty has a wide variety of subspecialties. I think in emergency cases like in severely burned patients, you can also learn the fundaments of reconstructions and this is also needed in 83% of the countries. A plastic surgical catalogue, this means that you have to perform a certain amount of operations, is also needed in most of the countries and you see even the big countries like Germany, Italy, Spain, United Kingdom, they require an operation catalogue. So, that you have a certified number done under supervision of an experienced plastic surgeon. The final exam is required in many countries, 91% and some of the countries even have sub exams every one or two years. For example, in the UK, they have an annual exam to which way you can fail and you of course have then to redo if you're not past the last year. And I think this is also a quality indicator of the curriculum of plastic surgeons. So, this results led to the conclusion that the board certified plastic surgeon is really of high value for patient safety and in many countries, their patients are not aware who's in front of them. If this is a beauty surgeon or this is really a real trained plastic surgeon. This is why the European Society published a position paper in 2022 on patient safety and plastic surgery and we visualized also the qualification. This is a modified a table which we have done in our European Leadership Forum together in I think it was in 2022 and you see that there are different keystones for qualifications and most of the stakeholders have only weekend courses or short elective periods in aesthetic surgery. This is true for example for paramedics or medical doctors. A medical degree is only true for the doctors and the specialization is also only a subgroup and only the plastic surgeon who has the full training has a full training in every part of the body and is in my opinion the most qualified plastic surgeon for aesthetic online so he has full training in every part of the body and is in my opinion and the most qualified. Sorry, this is the series which started. However, this does not mean that plastic surgeons don't have complications but still they have the highest qualification and when we look at the regions of the body, here you see the upper face, the nose, the lower face, breast, trunk and extremity. It's only the board-certified plastic surgeon who is trained in all of these regions. The ENT surgeon is trained in the face, the gynecologist in the breast, the ophthalmologist in the periorbital region but none of them is trained in other regions of the body and I think this is a quality indicator of our curriculum. So the commitment in this position paper of ESPRESS is to support education and science for plastic surgeons and also support jurisdiction especially in cases where expert witnesses are needed to also change jurisdiction in each country towards patient safety. For example, in Germany it's not possible to not allow plastic surgery to other doctors since this would contradict the basic right of practicing in any discipline you want. So, for example, we as plastic surgeons could also do heart surgery. Of course, we wouldn't but this would basically be possible and I think a further pillar which is very important also is to increase public awareness for the quality indicator of board certification as a plastic surgeon. So ESPRESS does press releases, is also active now on social media channels. Use the hashtag ESPRESS at Europe which gives you a good overview about the publications and our new website which will start in February or latest in March which will also contain a plastic surgeon search where patients can search for board certified plastic surgeons in their country. So I think it's a duty also for all of us as plastic surgeons that we protect our patients from so-called aesthetic surgeons which are undertrained and the risk of complications is certainly higher than in a well-trained plastic surgeon. This topic is important for many societies. Also ASPS has changed their website and you see there are many argues why to choose a board certified plastic surgeon and if you go to the ASPS website you will find further arguments why the training is so important to the patient safety. So thank you for your attention and in case you want to review the papers you find here the QR codes. They are under free access and you can download them and read them and we are happy if we get further comments and suggestions how to improve patient protections throughout Europe. Thank you for your attention. Thank you very much Ricardo. Yes you're right as a plastic surgeon we're facing globally the same issues so we need to try to stay together units ASPS one of the most representative societies in plastic surgery can help us through the global leadership forum as you already have said but also the role of the European society is very very important. I have a quick question for you and how do you think how can European surgeons contribute to the force of the ASPRS? Well of course everybody can contribute to ASPRS as an open society. Any plastic surgeon who is member of a national society is also member of the European society and there are many committees within the societies where we need young and active plastic surgeons to contribute and I think the key role is of ASPRS is that we collect information from national societies and spread them again throughout Europe. It doesn't have to be reinvented everything in any national society because the problems are very similar and I think this is the key role and we are very happy to have further co-players in European plastic surgeons surgery. Thank you Ricardo. We are at the end of this excellent webinar and Romina you're here I don't know we are all together. First of all I would like to thank you the American Society of Plastic Surgeons, the Sikh Pre-Italian Society signed the memorandum of understanding in 2013 so it is a long time we are collaborating together. Then I would like to thank our speakers tonight and today last but not least Stefania Tenla, Alessandra Veronese and I would like to thank Romina Valadez, would like to thank Amy Spellman and Madison Bow for their kind support and stay tuned for the next upcoming ASPRS Global Partners webinar and thank you again. Romina would you like to say something to our participants of the webinar and thank you. Yes absolutely thank you very much to all the participants. Thank you very much and we'll have more webinars coming so I encourage you to join the society and thank you to the speakers and everyone for attending today. Thank you, thank you, thank you and thank you everybody goodbye and thank you bye-bye thank you.

ASPS Global Partner Webinar

advanced skin cancer

secondary breast prosthetic surgery

plastic surgery education

integrated care pathways

capsular contractures

fat grafting

patient safety

multidisciplinary teams

professional societies

plastic surgery

Dr. Estefania Difasio

Romina Valadez

integrated care pathway

board certification

multidisciplinary approach

global partnership