Standards for aseptic techniques in medical aesthetic practices in the Benelux: Consensus recommendations.

INTRODUCTION: While the demand for aesthetic procedures is rising, complications are rising alongside. Infection is a frequent complication, there is therefore an increased need for strict aseptic technique, particularly in procedures breaching the skin. The level of training of practitioners carrying out these procedures varies and there are no comprehensive guidelines on aseptic aesthetic practice in the Benelux region. OBJECTIVE: Developing a step-by-step procedure for achieving and maintaining a high standard of aseptic conditions in a standard aesthetic practice in the Benelux region. METHODS: A consensus group of 10 aesthetic medical practitioners (dermatologists, plastic surgeons, and cosmetic physicians) representing the Benelux region convened to discuss best practice for aseptic techniques in medical aesthetics. Step-by-step procedures were recommended to achieve optimal aseptic practice in private facilities and define important considerations for reducing infection risk. Recommendations were based on current evidence and extensive clinical experience. RESULTS: Recommendations were made to achieve and maintain a high standard of asepsis and infection control. Guidance included maintaining high standard aseptic conditions of the injecting room, the injecting area on the patient, the injection procedure, the materials, and procedures commonly used to achieve aseptic conditions. CONCLUSIONS: This expert consensus summary publication recommends aseptic procedures, setting a standard with the goal of minimizing rates of complications in aesthetic clinical practice in the Benelux region.

Invited Comment on: "Hyaluronic Acid Gel Injection for the Treatment of Tear Trough Deformity: A Multicenter, Observational, Single-Blind Study." by Alberto Diaspro et al.

From this article of Diaspro and colleagues, we can safely conclude that it proves that HA fillers are an effective treatment of tear troughs. A full analysis of the face in general, and the peri-orbital area in particular, is essential to select the right candidates for this treatment. A thorough knowledge of the anatomy is essential to do this selection and to avoid possibly serious complications.Level of evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Role of Governance in Medical Societies-Doing the Right Thing, the Right Way.

BACKGROUND: Medical societies are an important driving factor in education and moving science forward. The better they function, the better for both science and patient outcomes. Good governance increases the likelihood and degree to which an organisation actually delivers on its purpose. OBJECTIVE: To find out what aspects of governance apply to a medical society. MATERIALS AND METHODS: A literature and Internet search were performed to find information on governance applicable to medical societies. RESULTS AND DISCUSSION: Extensive information and guidance on governance for non-profit organizations were found, but none that was specific for medical societies. A compilation of the most important aspects of Governance relevant for medical societies is presented: (1) Purpose, organization and structure-(Why do we need a society); (2) Participation, representation and board composition-(Who is involved); (3) Roles and responsibilities-(What is the job); (4) Culture, Integrity and ethics-(How do we approach the job); (5) Rules and Effectiveness-(How do we execute the job). CONCLUSION: Good governance for a medical society is what the Hippocratic oath is for any doctor. Directors of medical boards should be more aware of all aspects of governance. More publications on governance for medical societies could raise awareness of board directors and improve the outcome of medical non-profit organizations. Education and science will profit overall. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Considerations on the Demography of BIA-ALCL in European Countries Based on an E(A)SAPS Survey.

BACKGROUND: A growing body of evidence indicates that breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is associated with the use of certain breast implants. Regional variations have been reported, and a genetic susceptibility has also been suggested. However, large variations in the ability to correctly diagnose BIA-ALCL and to further report and register cases exist between countries and may in part explain variations in the demography. MATERIAL AND METHODS: A survey was conducted by The European Association of Societies of Aesthetic Plastic Surgery E(A)SAPS and sent to 48 European countries. The primary aim was to identify the total number of confirmed cases of and deaths from BIA-ALCL in each country during four consecutive measurements over a two-year period. RESULTS: An increase in BIA-ALCL cases during four repeated measurements from a total of 305 in April 2019 to 434 in November 2020 was reported by 23 of the 33 responding countries. A nearly 100-fold variation in the number of cases per million inhabitants was noted, where Netherlands had the highest rate (4.12) followed by Finland (1.99). Countries with the lowest reported rates were Austria (0.078), Romania (0.052) and Turkey (0.048). CONCLUSION: The current study displays a notable variation ßin the number of confirmed BIA-ALCL cases across Europe, even for countries with established breast implant registers. Variations in diagnosis and reporting systems may explain the differences, but the influence of genetic variations and the prevalence of high-risk implants cannot be excluded. Incomplete sales data along with medical tourism preclude an absolute risk assessment. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

EASAPS/ESPRAS Considerations in getting back to work in Plastic Surgery with the COVID-19 Pandemic - A European point of view.

The aim of this paper is to summarize the results of a consensus process and a European webinar of the two societies, European Association of Societies of Aesthetic Surgery (EASAPS) and the European Society of Plastic, Reconstructive and Aesthetic Societies (ESPRAS) on what is considered safe practice based on the scientific knowledge we have today. This review of the current situations gives considerations which have to be taken into account when getting back to work in plastic surgery with COVID-19 in Europe. At all times, one should be familiar the local and regional infection rates in the community, with particular emphasis on the emergence of second and third waves of the pandemic. Due to the fast-evolving nature of the COVID-19 pandemic the recommendations aim to be rather considerations than fixed guidelines and might need to be revised in near future.