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Bali/Indonesia
Announcement
Get detailed information at
[email protected] // [email protected] // http://isdsbali2011.com
April 7-10, 2011Bali International Convention CentreThe Westin Resort, Nusa Dua Bali, Indonesia
Congress President: Dr. Lis Surachmiati, Sp.KK, INDONESIA
3rd Spring Meeting of the International Societyfor Dermatologic Surgery (ISDS)in cooperation with:Indonesian Society of Dermatology & Venereology (PERDOSKI)
Don't miss to submit
your abstract until
February 28, 2011
REVISED
Program chairs: Atchima Suwanchinda M.D., THAILAND //Emily Piansay-Soriano M.D., PHILIPPINES// Kai Munte M.D. NETHERLANDS
Cutting edge dermatologic surgery in the Island of Gods
We warmly invite you to participate in a most momentus event - The 3rd Spring Meeting of the International Society for Dermatologic Surgery will be held in Bali, Indonesia. Highly structured patient management in rejuvenation, advances in skin tightening technology, tumor and reconstructive surgery, dermoscopy, basics of dermatologic surgery, AdipoStem cell treatment, �llers, neurotoxins, and much more will be yours to choose from. In Indonesia and all aorund the world, dermatologic surgery is practiced as an integral part of dermatologic services to patient on a daily basis. It has been proven that dermatologists have an undeniable excellent track record of safety using many o�ce based procedures. In order to maintain it, exposure to updates on dermatological surgery to practicing dermatologists and residents of dermatology is a must. The 3rd Spring Meeting consists of symposiums, courses, workshops led by masters in the �eld of dermatologic surgery, and social events including, wine and dine at breathtaking places, and a golf tournament on a world class course. Paralel with the event an industrial expo will also take place. On top of it all, enjoy Balinese hospitality amid breathtaking surroundings, partake in the social events - cultural tours, culinary wine-and-dine, and golf tournament on a world class course. Let’s create individual visions, discuss and share experiences and, form international friendships.
See you in Bali!
Lis Surachmiati MDCongress President
WELCOME TO INDONESIA !
Chairman Dr. Lis Surachmiati, Sp.KK Co-chairman Dr. AAGP Wiraguna, Sp.KK(K)General secretary Dr. Sandra Widaty, Sp.KK(K)Vice secretary Dr. Dewi Lestarini, Sp.KK Dr. Ni Made Indah Puspasari, Sp.KKSecretariat Coordinator Dr. Jonathan R. SubektiTreasurer Dr. Tina Wardhani Wisesa, Sp.KK(K) Vice treasurer Dr. Elisa Miranda, Sp.KKFund raising Dr. Tina Wardhani Wisesa, Sp.KK(K) Dr. Edwin Djuanda, Sp.KK Dr. R W Nanda Dewi Sp.KK Dr. Inne Arline Diana, Sp.KK(K) Prof. Dr. Sjaiful Fahmi Daili, Sp.KK(K)Transportation and accommodation Dr. Ari Muhandari Ardhie, Sp.KK Dr. Susanti Budiamal Sp.KK Dr. Fitria Agustina, Sp.KKSessions and social events Dr. Lili Legiawati, Sp.KK Dr. Yufanti Sujudi, Sp.KK Dr. Remenda Siregar, Sp.KK Dr. Roro Inge Ade Krisanti, Sp.KK Dr.Ni Made Indah Puspasari, Sp.KK
Industrial exhibitions and ancillaries Dr. Eddy Karta, Sp.KK Dr. IGN Darmaputra, Sp.KKScienti�c committee Atchima Suwanchinda M.D./Thailand Emily Piansay-Soriano M.D./ Philippines Kai Munte M.D./Netherlands DR Dr. Indah Yulianto, Sp.KK(K) Dr. Herman Cipto, Sp.KK(K) DR. Dr. Aida Suriadiredja, Sp.KK(K) Dr. Moerbono Mochtar, Sp.KK Dr. H. Anis Irawan Anwar, Sp.KK Dr. Sudarto Oeiria, Sp.KK (K) Dr. Hj. Sri Lestari KS, Sp.KK(K) Workshop Dr. Gunawan Budisantoso, Sp.KK DR. Dr. Made Wardhana SpKK Dr. Abraham Arimuko, Sp.KK Dr. R W Nanda Dewi Sp.KK Dr. Irma Bernadette, Sp.KK Dr. Sjarief Hidayat, Sp.KK Dr. IGN Darmaputra, Sp.KK Dr.Ni Made Indah Puspasari, Sp.KKPublic relations Dr. Endi Novianto, Sp.KK Dr. Made Surdajana, Sp.KKFood and beverages Dr. Wieke Triestianawati, Sp.KK(K)
CONGRESS COMMITTEESPATRONSThe Minister of Health of the Republic of Indonesia.The Governor of Bali.ADVISORS Rector of the Udayana University, Bali.Dean of the Faculty of Medicine, Udayana University, Bali.President Director of Sanglah General Central Hospital (RSUP Sanglah).President of the Indonesian Medical Association.STEERING COMMITTEE (PERDOSKI)Dr. Titi Lestari Sugito, SpKK (K) - President of the Indonesian Society of Dermatology and Venereology (PERDOSKI).
The Executive Board of the International Society for Dermatologic Surgery (ISDS).Dr. Edwin Djuanda, SpKK - Chairman of the Study Group for Dermatologic Surgery (ISDV).Prof. Dr. Made Swastika Adiguna, Sp.KK(K).
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INVITED FACULTY
ISDS OFFICER
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ISDS OFFICERS PRESIDENT
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AAGP Wiraguna INDONESIAAbraham Arimuko INDONESIAAgnes M. Espinoza-Thaebtharm PHILIPPINES Aida Suriadiredja INDONESIAAileen Montero PHILIPPINES Alina Fratila GERMANYAngela Cumagun PHILIPPINES Anis Irawan Anwar INDONESIAAnthony V. Benedetto USAAnthony Handoko INDONESIAAtchima Suwanchinda THAILAND
Claudine S. Roura PHILIPPINESCoen Gho NETHERLANDSConstantin Stan ROMANIA
Bambang Ratio Setiyarso INDONESIA
R. Musliani Moestopo INDONESIARaden Pamudji INDONESIARemedios Manuel PHILIPPINESRemenda Siregar INDONESIAReni Wiyakti Nanda Dewi INDONESIARonald L. Moy USARoro Inge Ade Krisanti INDONESIARoy Chio SINGAPORE
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Sabine Zenker GERMANYSahar Foad Ghannam KUWAITSandra Widaty INDONESIASjarief Hidayat INDONESIASomesh Gupta INDIASonja Sattler GERMANYSri Aryani Sudharmono INDONESIASri Ellyani INDONESIASri Lestari INDONESIASudarto Oeiria INDONESIASudigdo Adi INDONESIASusanti Budiamal INDONESIASutirto Basuki INDONESIA
Tanja C. Fischer GERMANYTeresia L.Toruan INDONESIATeresita S. Ferrariz PHILIPPINESThurakkal Salim INDIATiti Lestari Sugito INDONESIA
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Welf Prager GERMANYWichai Hongcharu THAILAND
Yulia Faida Yahya INDONESIA
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MMade Wardhana INDONESIAMaria Cristina Puyat PHILIPPINESMaria Isabel Mangubat PHILIPPINESMarina Landau ISRAELMark Michael Tanner GERMANYMarwali Harahap INDONESIAMatthias Sandhofer AUSTRIAMaurizio Podda GERMANYMelania Sasongko INDONESIAMichael H. Gold USAMihaela Leventer ROMANIAMiriam Emily Piansay-Soriano PHILIPPINESMitchel Paul Goldman USAMoerbono Mochtar INDONESIA
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Jean D.A. Carruthers CANADAJe�rey A. Klein USA
Gerhard Sattler GERMANYGunawan Budisantoso INDONESIA
Herman Cipto INDONESIA
Eckart Haneke GERMANYEdwin Djuanda INDONESIAEncarnation Legaspi PHILIPPINESEndang Sutedja INDONESIAEndra Yustin INDONESIA
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Kai Munte NETHERLANDSKei Negishi JAPANKimberly J. Butterwick USA
Lawrence Marshall Field USALili Legiawati INDONESIALilik Norawati INDONESIALis Surachmiati Suseno INDONESIALisa Donofrio USA
FX. Hanny Suwandhany INDONESIA
II.G.A. Sumedha Pindha INDONESIAIndah Handayani INDONESIAIndah Yulianto Danukusumo INDONESIAIne Arline Diana INDONESIAIrma Bernadette INDONESIAIsabel Lopez Nazal PHILIPPINES
Jorge Ocampo Candiani, M.D. MEXICO
President-ElectJoseph Alcalay, M.D. ISRAEL
Vice PresidentHenry W. Randle, MD, PhD, Professor USA
SecretaryAnthony V. Benedetto, D.O., FACP USA
HistorianDiane I. Roseeuw, M.D. BELGIUM
Founder PresidentPerry Robins, M.D. USA
Executive DirectorC. William Hanke, MD, MPH, FACP USADr. med. Gerhard Sattler GERMANY
Associate Executive DirectorDr. med. Sonja Sattler GERMANY
Immediate Past PresidentGary J. Brauner, M.D. USA
Board of DirectorMiriam Emily Piansay-Soriano, M.D. PHILIPPINESDimitra Dasiou-Plakida, MD GREECEDoris Hexsel, M.D. BRAZILMarina Landau, M.D. ISRAELMihaela Leventer, M.D. ROMANIAJ. Ramsey Mellette, M.D. USAKai Munte, M.D. NETHERLANDSDr. med. Birgit Wörle GERMANYKevin S. Pinski, M.D. USAMaurizio Podda, MD, PhD GERMANYAntonio Rusciani, M.D. ITALYNeil S. Sadick, MD, FACP, FAACS, FACPh USA
TreasurerLoek Habbema, M.D. NETHERLANDS
Dewi Lestarini INDONESIADhiana Ernawati Adiprajog INDONESIADoris Hexsel BRAZIL
NNicoletta Frasca ITALYNugrohoaji Dharmawan INDONESIA
PPetra Becker-Wegerich SWITZERLANDPrasetyadi Mawardi INDONESIA
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12.30 - 13.30 am
10.00 - 10.30 am COFFEE BREAK & EXHIBITIONExhibition Gallery & Nusantara Foyer
DAY 1 - The Westin Resort
TENTATIVE PROGRAM
Thursday, April 7th 2011
Chair & Co-chair : Herman Cipto (Indonesia),Aida Suriadiredja (Indonesia),Marwali Harahap (Indonesia),Remenda Siregar (Indonesia),Eckart Haneke (Germany),Kai Munte (Netherlands)
Chair & Co-chair : M. Yulianto Listiawan, Amaranila Lalita,Emily Soriano (Philippines),Sabine Zenker (Germany)
(Jakarta Room)
Flaps & Grafts: Cheek // Jorge Ocampo-Candiani (Mexico) Flaps & Grafts: Orbital // Alina Fratila (Germany)Flaps and Grafts Oral RegionFlaps and Grafts in nail surgery // Eckart Haneke (Germany)Suture techniques // Eckart Haneke (Germany) Wound healing managementSurgical gems and pitfalls
7:30am - 8:00am REGISTRATION
LUNCH & EXHIBITIONExhibition Hall
13.30 - 14.30 am
14.30 - 16.00 am
OPENING CEREMONY & EXHIBITION PLENARY A
Fundamentals of dermatologic surgery Speech Congress President (5‘) Speech ISDS President (5‘) The Travelling Chair and Indonesia Since 1988 and Progression into the ASDS / ISDS International Mentorship Exchange Program (25‘)// Lawrence M. Field (USA) Dermatology Surgery in Indonesia (25‘) // Marwali Harahap (Indonesia)
a. SYMPOSIUM AUnderstanding acne and acne scar treatmentLectures of 10’ each
(Nusantara 2-3 Room)
Dangerous zones in the face and neckHow to do e�cient skin biopsy // Mark Tanner (Germany)Flaps & Grafts: Nose
Understanding Acne: Pathophysiology of acne//Theresia L. Toruan (Indonesia) Acne Treatment Update 2011// Sahar Ghannam (Kuwait)Dermabrasion in acne scars// Imelda Cervantes (Philippines)Acne scar treatment with sublative rejuvenation// Wichai Hongchar (Thailand) Erbium Yag laser & excision in the treatment of acne scarsDermaroller update // Anis Irawan Anwar (Indonesia)Electrobrasion of Acne Scars // Emily Soriano (Philippines)New Devices and trends for Acne scar treatment//Christina Puyat (Philippines)Discussion group Acne scar treatment(30`) 4 patients beforeand after The international approach European – Asian – US– Middle East (Best treatment – My way of how I did itand possible complication and how to prevent)
b. MASTER COURSE BAging Body and Body Rejuvenation
( Nusantara 1 Room )
Anatomy of the body for surgical procedures// Gerhard Sattler (Germany)Understanding Tumescent Local Anaesthesia for Liposuction// Matthias Sandhofer (Austria)Art & science of Liposuction Understanding technology and how to choose(Light/Laser/RF/Ultrasound) for body tighteningLaser and Light in body aging and body rejuvenation// Angela Cumagun (Philippines)Bromhydrosis: Surgical and non surgical approaches// Indah Yulianto (Indonesia)Striae: Surgical and non surgical approaches// Emily Soriano (Philippines)Cellulite: Surgical and non surgical approaches// Doris Hexsel (Brazil)Integrative treatment for body rejuvenation// Nicoletta Frasca (Italy)Tummy tuck using tumescent local anesthesia- my technique// Edwin Djuanda (Indonesia)Future trends and new technologys// Gerhard Sattler (Germany)Complications and how to prevent // Sri Lestari (Indonesia)
Lectures of 20’ each
Discussion group Aging Body(30`) 4 patients before and after The international approach European – Asian – US – Middle East (Best treatment – My way of how I did it andpossible complication and how to prevent)
c . MASTER COURSE CLearn how to do Dermatologic SurgeryLectures of 20’ each
Anatomy of the face and body fat for surgical procedures// Kai Munte (Netherlands)How to do LA, nerve blocks and tumescent technique//Remedios Manuel (Philippines)
Discussion group (30`) 4 patients before and after The international approach European – Asian – US – Middle East(Best treatment – My way of how I did it and possible complication and how to prevent)
(Nusantara 2-3 Room)
Anatomy of the face for surgical procedures// Matthias Sandhofer (Austria)Understanding technology and how to choose(Light/Laser/RF/Ultrasound) // Isabel B. Mangubat (Philippines)Understanding of the art & science of Injection(Fillers, Botox, Fat) // Gerhard Sattler (Germany)Understanding the art & science of Lifting with threads// Constantin Stan (Romania)Laser and light for facial rejuvanation // Kei Negishi (Japan)RF and Ultrasound for facial rejuvanation// Cristina Puyat (Philippines)Mini face lift for the aging face // Guillermo Blugerman (Argentina)Combined Surgical procedure to treat the aging faceAlina Fratila (Germany)Integrative aesthetic treatment for the aging face// Atchima Suwanchinda (Thailand)Best combination treatments for the aging face// Marina Landau (Israel)Future trend and new technology // Welf Prager (Germany)Complications and how to prevent
8:00 - 12:30 noon a . MASTER COURSE AThe Aging Face and How to Manage Rejuvenate Lectures of 20’ each
Chair & Co-chair : Aryani Sudharmono (Indonesia),Abraham Arimuko (Indonesia),Sudarto Oeiria (Indonesia),Sri Ellyani (Indonesia),Matthias Sandhofer (Austria),
Discussion group Aging Face(30`) 4 patients beforeand after The international approach European – Asian – US – Middle East (Best treatment – My way of how I did it and possible complication and how to prevent)
(Nusantara 2-3)
Chair & Co-chair : Sandra Widaty (Indonesia),Bambang Ratio Setiyarso (Indonesia),R W Nanda Dewi (Indonesia),Edwin Djuanda (Indonesia),Gerhard Sattler (Germany)
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Chair & Co-chair : Atchima Suwanchinda (Thailand), Kei Negishi(Jepang)
c. SYMPOSIUM CWhat’s new in the treatment of pigmentationproblems and melasmaLectures of 10’ each
AnatomyPathophysiologyTopical, oral and intravenous treatment options// Sahar Ghannam (Kuwait)Chemical Peels in dyschromia // Marina Landau (Israel)Laser treatment for melasma // Kei Negishi (Japan)Integrative treatment for dyschromia //Atchima Suwanchinda (Thailand)Future trends in Dyschromia treatmentsDiscussion group dyschromia treatment(30`) 4 patients beforeand after The international approach European – Asian – US –Middle East (Best treatment – My way of how I did itand possible complication and how to prevent)
( Jakarta Room )
Chair & Co-chair : Paul Tahalele (Indonesia), Darwis Toena(Indonesia), Teresita Ferrariz (Philippines),Kai Munte (Netherlands)
Discussion group Varicous vein treatment(30`) 4 patientsbefore and after The international approach European– Asian – US – Middle East (Best treatment – My way of howI did it and possible complication and how to prevent)
(Nusantara 1 Room)b. SYMPOSIUM BPhlebology & SclerotherapyLectures of 10’ each
Pathophysiology of venous insu�ciency //Moerbono Mochtar (Indonesia)The role of super�cial venous surgery in treatmentof venous pathology // Kai Munte (Netherlands)Sclerosants in the management of venous disease// Teresita S. Ferrariz (Philippines)Endovenous ablation using lasers and radiofrequency// Girish Munavalli (USA)Foam sclerotherapy Future Trends in varicous vein treatment
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COFFEE BREAK & EXHIBITIONExhibition Gallery & Nusantara Foyer
11:00 - 11:30 pm 15:30 - 16:00 pm COFFEE BREAK & EXHIBITIONExhibition Gallery & Nusantara Foyer
13:30 - 15:30 pm a. SYMPOSIUM FStem cells therapy
(Nusantara 2-3 Room)
Stem cells and dermatologic surgery.Where are we now?// Sabine Zenker (Germany)Non Cultured Autologous Adipose-derived Stem cells therapy// Indah Yulianto (Indonesia)Paracrine E�ect from Umbilical Cord Stem Cells forAnti Aging TherapyStem cells in the management of acne scar repairUse of stem cells for Autologous Breast Augmentation//Roy chio (Singapure)Safety Con�rmed of Breast Augmentation with Auotologousfat Stem Cells // Agnes M Espinoza (Philippines)Stem cells in management of venous insu�ciency
Chair & Co-chair : I.G.A. Sumedha Pindha (Indonesia), FX. Hanny Suwandhany (Indonesia),Marina Landau (Israel)
b. SYMPOSIUM GChemical peels that works
(Nusantara 1 Room)
When to use which Chemical PeelChemical Peeling for facial rejuvenation// Marina Landau (Israel)Chemical Peeling for Indonesian skin //R W Nanda dewi (Indonesia), FX. Hanny Suwandhany(Indonesia)Chemical Peeling for Acne/or Melasma// R.W. Nanda Dewi (Indonesia)New approach in scar treatment (RF and Acoustic Waves)// Sabine Zenker (Germany)Chemical Peel at body skin // Isabel Lopez-Nazal (Philippines )Complications in Chemical Peels // Marina Landau ( Israel)Discussion group Stem cell therapy, my �rst results(30`)4 patients before and afterThe international approachEuropean – Asian – US – Middle East(Best treatment – My way of how I did it andpossible complication and how to prevent)
Chair & Co-chair : Indah Yulianto (Indonesia),Endra Yustin (Indonesia),Sudigdo Adi (Indonesia),Titi Lestari Sugito (Indonesia),Sabine Zenker (Germany),Atchima Suwanchinda (Thailand)
Stem cells Therapy Pitfalls and complications// Atchima Suwanchinda (Thailand)Discussion group Stem cell therapy, my �rst results(30`)4 patients before and afterThe international approach European – Asian – US –Middle East (Best treatment – My way of how I did itand possible complicationand how to prevent)
DAY 2 - The Westin Resort Friday, April 8th 2011
Chair & Co-chair : Indah Yulianto (Indonesia) Sri Lestari (Indonesia)
07:15 - 08:00 pm a. MORNING SESSION AHow to produce natural result with fat injectionAutologous Fat Injection in Aesthetic Surgery
(Nusantara 2-3 Room)
Chair & Co-chair : Sudarto Oeiria (Indonesia),Susanti Budiamal (Indonesia)
b. MORNING SESSION BFractional lasers for rejuvenationUpdates on fractional laser technology // Michael H. Gold (USA)
(Nusantara 1 Room)
08:00 - 09:00 pm PLENARY BCurrent treatment options for managing male pattern baldness:
Chair & Co-chair : Gunawan Budisantoso (Indonesia),AAGP Wiraguna (Indonesia)
How to Transplant for Maximal Result (30‘)My personal most e�cient approach in hair transplantation// Coen Gho (Netherlands)
Surgical and Non-surgical approach for di�cult skin problems
Chair & Co-chair : Lilik Norawati, Dhiana Ernawati (Indonesia)
b. SYMPOSIUM E (Nusantara 1 Room)
Lectures of 10’ each
09:00 - 11:00 pm a. SYMPOSIUM DLiposuction for cosmetic & non-cosmetic Indication
Chair & Co-chair :
(Nusantara 2-3 Room)
Lectures of 10’ each
Acne Scar Management in Darker Skin// Sahar Ghannam (Kuwait)Non-Surgical Approach of Stretch Marks // Nicolleta Frasca (Italy)Cultered Adipose-derived Stem-cells therapy for skin injury// Indah Yulianto (Indonesia)Laser and Non-laser Approach for Melasma// Atchima Suwanchinda (Thailand)Body skin tightening, which system works // Angela Cumagun(Philippines)Kryolipolysis for non invasive fat reduction: Does it work?// Matthias Sandhofer (Austria)Vitiligo Therapy, my personal approachNon-facial skin �llers // Wichai Hongcharu (Thailand)The Versatility of Photodynamic Theraphy in Dermatology//Sahar Al-Natour (Saudi Arabia)Discussion group my most surprising case(30`)4 patients before and afterThe international approachEuropean – Asian – US – Middle East(Best treatment – My way of how I did it andpossible complication and how to prevent
Anatomy for Liposuction // Susanti Budiamal (Indonesia)New devices in Liposuction (RF, Laserlipolysis, Ultrasound)// Gerhard Sattler (Germany)Liposuction of the neck // Lawrence M. Field (USA)Liposuction in LipedemaLiposuction for Lipoma // Moerbono Mochtar (Indonesia)Autologous fat transfer to breast and buttocks, how to getlong lasting results// Claudine Roua (Philippines)Liposuction in dangerous area// Lawrence M. Field (USA)Liposuction to assist Flaps and Grafts // Lawrence M. Field (USA)Lipo�lling for Atrophic Skin Diseases // Lis Surachmiati (Indonesia)Lipo�lling for dark eye circles // Gerhard Sattler (Germany)Complications in Liposuction// Guillermo Blugerman (Argentina)Discussion group Liposuction(30`) 4 patients before and afterThe international approach European – Asian – US – Middle East(Best treatment – My way of how I did itand possible complication and how to prevent)
Lis Surachmiati (Indonesia), MoerbonoMochtar (Indonesia)
11:30 - 12:30 pm a. FREE COMMUNICATION AModerator: Lawrence Marshall Field (USA)Motives for cosmetic procedures in Saudi women//Sahar Al- Natour (Saudi Arabia)Zerona Non-invasive liposuction for full body contouring //Claudine Roura (Phillipines)VASER High de�nition Liposculpture, the next generationin bodysculpture // Claudine Roura (Phillipines)New Evolution Biotechnology Multiple Injections//Indah Yulianto (Indonesia)
(Nusantara 2-3 Room)
b. FREE COMMUNICATION BModerator: Marwali Harahap (Indonesia)
(Nusantara 1 Room)
LUNCH & PRAYINGExhibition Hall
12:30 - 13:30 pm
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16:00 - 18:00 pm a. SYMPOSIUM HReconstructive surgery for skin tumors
(Nusantara 2-3 Room)
Anatomy for tumor surgery // Maurizio Podda (Germany)Mohs Micrographic surgery // Ron Moy (USA)Tumor surgery of the ear Tumor surgery of the LipsTumor surgery of the eye lids // Alina FratilaTumor surgery of the nails // Eckart Haneke (Germany)Complications in tumor surgeryDiscussion group tumor surgery(30`)4 patients before and afterThe international approachEuropean – Asian – US – Middle East(Best treatment – My way of how I did it andpossible complications and how to prevent)
Chair & Co-chair : Herman Cipto (Indonesia),Made Wardhana (Indonesia),Mihaela Leventer (Romania),Roro Inge Ade Krisanti (Indonesia)
b. SYMPOSIUM IManagement of cellulite
(Nusantara 1 Room)
Anatomy and classi�cation of cellulite // Doris Hexsel (Brazil)New lessons in cellulite therapy // Marina Landau (Israel)Botanical extracts for cellulite treatment // Doris Hexsel (Brazil)Surgical management of Cellulite // Doris Hexsel (Brazil)New equipments to manage cellulite – How e�ective are they?
19:00 pm GALA DINNER
Laserlipolysis: the only treatment option for a permanent result?// Gerhard Sattler ( Germany)Complications in cellulite treatments// Michael Gold (USA)Discussion group cellulite(30`)4 patients before and afterThe international approachEuropean – Asian – US – Middle East(Best treatment – My way of how I did it andpossible complications and how to prevent)
Chair & Co-chair : Raden Pamudji (Indonesia) ,Doris Hexsel (Brazil), Michael Gold (USA)
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11:00 - 11:30 am COFFEE BREAK & EXHIBITIONExhibition Gallery & Nusantara Foyer
11:30am-12:30pm a. FREE COMMUNICATION CModerator
(Nusantara 2-3 Room)
b. FREE COMMUNICATION DModerator: Kai Munte (Netherlands)
(Nusantara 1 Room)
Discussion group: combined rejuvenation procedures(30`)4 patients before and afterThe international approachEuropean – Asian – US – Middle East(Best treatment – My way of how I did it andpossible complications and how to prevent)
15:30 - 16:00 pm COFFEE BREAK & EXHIBITIONExhibition Gallery & Nusantara Foyer
16:00 - 18:00 pm (Nusantara 2-3 Room)CLOSING CEREMONY
Chair & Co-chair : Sutirto Basuki (Indonesia)Dewi Lestarini (Indonesia),Anthony Handoko (Indonesia),Alina Fratila (Germany), Maria Cristina Puyat (Philippines)
Classical Blepharoplasty // Alina Fratila (Germany)Discussion group my best case periorbital rejuvenation(30`)4 patients before and afterThe international approachEuropean – Asian – US – Middle East(Best treatment – My way of how I did it andpossible complications and how to prevent)
13:30 - 14:30 pm
Chair & Co-chair : Herman Cipto (Indonesia),Remenda Siregar (Indonesia),Maurizio Podda (Germany), Ron Moy (USA)
Chair & Co-chair : Yulia Farida Yahya (Indonesia),Musliani Moestopo (Indonesia),Edwin Djuanda (Indonesia),Nugrohoaji Dharmawan (Indonesia)
Mohs micrographic surgery How does it work? // Eckart Haneke (Germany)Pitfall of Mohs Micrographic Surgery in Dermato�brosarcomMohs Micrographic Surgery for SCC//Mihaela Leventer (Romania)Complications in Mohs micrographic surgery // Ron Moy (USA)Discussion group how to perform MOSin di�erent parts of the world(30`)4 patients before and afterThe international approachEuropean – Asian – US – Middle East(Best treatment – My way of how I did it andpossible complications and how to prevent)
Surgical treatment options for non melanomaskin cancer (Mohs Surgery)
a. SYMPOSIUM L (Nusantara 2-3 Room)
Lectures of 10’ each
12:30 - 13:30 pm LUNCH & EXHIBITIONExhibition Hall
Anatomy for periorbital treatments// Matthias Sandhofer (Austria)Topical treatment options for periorbital rejuvenation// Encarnacion Legaspi (Philippines)Erbium Yag resurfacing is it still in mode?// Petra Becker-Wegerich (Switzerland)CO2 Laser VS Fractional resurfacing in the periorbital area//Alina Fratila (Germany)Chemical Peels in the periorbital areaRapid Technique of Oriental Upper Lid Blepharoplasty//Edwin Djuanda (Indonesia)Dark eye circle treatment options// Maria Cristina Puyat (Philippines)
Surgical options for periorbital rejuvenationb. SYMPOSIUM M (Nusantara 1 Room)
Lectures of 10’ each
DAY 3- The Westin Resort Saturday, April 9 2011th
Chair & Co-chair : Gunawan Budisantoso (Indonesia),Endang Sutedja (Indonesia)
07:15 - 08:00 am a. MORNING SESSION CFlaps and graftsFlap and Graft in Di�cult Facial Defect// Mihaela Leventer (Romania)
(Nusantara 2-3 Room)
Chair & Co-chair : Irma Bernadette (Indonesia),Inne Arline Diana (Indonesia)
b. MORNING SESSION DLaser for vascular lesionsLaser for Vascular lesions
(Nusantara 1 Room)
08:00 - 09:00 amIntegrative medicine for rejuvenation: the future? (25`)// Achima Suwanchinda ( Thailand)The role of lasers and energy based devices indermatologic surgeryNew approaches and devices for rejuvenation Face + Body(25´)
(Nusantara 2-3 Room)
Chair & Co-chair : Sudarto Oeiria (Indonesia),Indah Yulianto (Indonesia)
PLENARY C
09:00 - 11:00 am
Pathophysiology of VitiligoChallenges in surgical management of vitiligo// Ronny Handoko (Indonesia)Autologous transplants in the management of vitiligo// Thurakkal Salim (India)E�ectivity of excimer lasers in treatment of vitiligo// Bing Wibisono (Indonesia)Trends and visions in vitiligo therapy // Somesh Gupta (India)Complications in vitiligo therapyDiscussion group cellulite(30`)4 patients before and afterThe international approachEuropean – Asian – US – Middle East(Best treatment – My way of how I did it andpossible complications and how to prevent)
(Nusantara 2-3 Room)
Chair & Co-chair : Lili Legiawati (Indonesia), Somesh Gupta (India)
a. SYMPOSIUM JUpdate on surgical management for pigmentary disordersLectures of 10’ each
Anatomy for botulinum toxin treatments and volume �lling// Gerhard Sattler (Germany)How to choose the right dermal �ller// Kimberly J. Butterwick (USA)Super�cial �lling and rejuvenation (Mesotherapy etc)// Nicoletta Frasca ( Italy)Platelet Rich Plasma helps tighten the facial skin?// Nicoletta Frasca (Italy)Botulinum toxin products which di�erences are there?// Welf Prager (Germany)The new �ller generation: subdermal �llers( Sculpta, Radiesse,highly linked HA)How to get the best in facial fat grafting// Lisa DonofrioDi�erent techniques of volume �lling
b. SYMPOSIUM KFacial Rejuvenation, Face lift, Volume �llers,Volumetric Fillers, Fat, Botulinum toxinLectures of 10’ each
(Nusantara 1 Room)
Dark eye circles treatment with �llers or fat// Emily Soriano (Philippines)The perfect lip // Sahar Ghannam (Kuwait)Facelift or fat graftingWhen to add fractionated Lasersystemsor RF devices for facial rejuvenation // Alina Fratila (Germany)Complications in �ller and botulinum toxin treatments
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DAY 4 - Sanglah hospitalSunday, April 10th 2011
Co Instructor : Indah Yulianto (Indonesia) Sri Lestari (Indonesia) Emily Soriano (Philippines) Guillermo Blugerman (Argentina)
08:00 - 12:00 noon WORKSHOP AAbdomen Lateral Upper Thigh LiposuctionINSTRUCTOR : Emily Piansay-Soriano (Philippines), Sri Lestari (Indonesia), Guillermo Blugerman (Argentina)
(Sanglah Hospital)
Co Instructor : Gerhard Sattler (Germany) Edwin Djuanda (Indonesia) Moerbono Mochtar (Indonesia) Made Wardhana (Indonesia)
Autologous Fat Augmentation INSTRUCTOR : Gerhard Sattler (Germany), Edwin Djuanda (Indonesia)
WORKSHOP C (Operating Room Sanglah Hospital)
08:00 - 12:00 noon
Co Instructor :Lis Surachmiati (Indonesia) Maria Christina Puryat (Philippines) Melania Sasongko (Indonesia) Prasetyadi Marwadi (Indonesia)
WORKSHOP EFillers
INSTRUCTOR : Maria Cristina Puyat (Philippines), Lis Surachmiati (Indonesia), Petra Becker Wegerich (Switzerland)
(Sanglah Hospital)
Co Instructor : Atchima Suwanchinda (Thailand) R. Musliani Moestopo (Indonesia) Sri Ellyani (Indonesia) R W Nanda Dewi (Indonesia) Sjarief Hidayat (Indonesia)
WORKSHOP GBotox BeginnerINSTRUCTOR : Isabel Mangubat (Philippines)
(Sanglah Hospital)
12:00 noon -16:00 pm
Co Instructor : Enny Widjaja (Indonesia) Laksmi Duarsa Irma Bernadette (Indonesia)
Chemical PeelingINSTRUCTOR : Marina Landau (Israel), Lili Supardiman (Indonesia), FX. Hanny Suwandhany (Indonesia) Abraham Arimuko (Indonesia)
WORKSHOP F (Sanglah Hospital)
Co Instructor : Sri Ellyani (Indonesia) R W Nanda Dewi (Indonesia) Inne Arline Diana (Indonesia)
WORKSHOP HBotox AdvanceINSTRUCTOR : Jean D.A. Carruthers (Canada), Welf Prager (Germany), Maria Isabel Mangubat (Philippines)
(Sanglah Hospital)
INSTRUCTOR : Lawrence Marshall Field (USA), Eckart Hanneke (Germany), Gunawan Budisantoso (Indonesia), Mihaela Leventer (Romania),Co Instructor :Lawrence Marshall Field (USA) Gunawan Budisantoso (Indonesia) Remenda Siregar (Indonesia) Eckart Haneke (Germany) Herman Cipto (Indonesia)
WORKSHOP DFlap Surgery
(Operating Room Sanglah Hospital)
12:00 noon -16:00 pm
Co Instructor : Angeles de Leon Alina Fratila (Germany) Susanti Budiamal (Indonesia) Sudarto Oeria (Indonesia) Anis Irawan Anwar (Indonesia)
WORKSHOP BAsian Blepharoplasty vs Caucasian BlepharoplastyINSTRUCTOR : Angeles de Leon, Alina Fratilla (Germany), Sudarto Oeiria (Indonesia), Agnes M. Espinoza (Philippines) Guillermo Blugerman (Argentina)
(Operating Room Sanglah Hospital)
8
GENERAL INFORMATIONVENUEBali International Convention CentreThe Westin ResortNusa DuaBali 80363 IndonesiaPhone: (62)(361) 771906
DEPOSIT POLICY
HOTEL ACCOMMODATIONS AND RESERVATIONS
The Organizing Committee has appointed the Sari Bali Convex as the O�cial PCO to coordinate all hotel reservation requests. All participants are entitled to special hotel rates that can be obtained by making their reservation through the PCO, which will o�er the most convenient and e�cient accommodation service.
* In the event of non-arrival, the hotel will automatically release the reservation and all payments will be non-refundable.* Any change and cancellation should be informed by e-mail or fax to the PCO in advance.* All bank charges will be deducted from the refund amount.* Please note that for administrative reasons, refunds will be made after the Congress. The cancellation policy for group reservations will be included in the reservation invoice
To make a hotel reservation, please use our secure on-line registration system.
Please visit o�cial website : http://ISDSBali2011.com
In each hotel a limited number of rooms has been provisionally reserved for Congress participants. It is strongly advised to book as early as possible to ensure reservation of the preferred hotel. Hotels rooms will be allocated on a �rst come �rst served basis. Hotel rooms will be in extremely high demand in April 2011 so we encourage you to make reservations as early as possible.
ISDS HOTEL RATES 2011
NUSA DUA BEACH, NUSA DUA BALISuperior Room : Rp.1.300.000Deluxe Room : Rp.1.450.000
NOVOTEL, NUSA DUA BALIDeluxe Room : Rp.1.500.000/nett
THE GRAND BALI, NUSA DUA BALIDeluxe Room : Rp.1.050.000Pool Acces Room : Rp.1.300.000
WESTIN, NUSA DUA BALIDeluxe Room : Rp.2.100.000
THE LAGUNA, NUSA DUA BALIDeluxe Studio Room : Rp.2.400.000Guest Room : Rp.2.100.000
GRAND HYATT, NUSA DUA BALIGrand King : Rp.2.100.000Club Ocean King : Rp.2.200.000
INNA PUTRI BALI, NUSA DUA BALIDeluxe Room : Rp.950.000/nettSuperior Room : Rp.850.000/nett
WHEN TO BOOK A ROOM
REGISTRATION
OFFICAL LANGUAGE IS ENGLISH
o A valid credit card is required by the PCO to con�rm all reservations. The PCO cannot proceed with reservations unless all payment details are complete.o Upon making the reservation, the cost of two nights’stay will be debited from your credit card by the Housing Bureau, Kim’s Travel Service. The remaining balance will be charged to your card 45 days prior to your check-in. o We can also con�rm reservations after remittance of the cost of at least 2 nights’ stay to the bank account below within one week. The remaining balance must be remitted at least 45 days prior to your check-in. o Room payments should be made to PCO. Other personal expenses such as breakfast, phone calls, room service, mini-bar etc. can be paid directly to the hotel front desk when you check out.
CANCELLATION & REFUND POLICY(FOR INDIVIDUAL RESERVATIONS)
1. January 7th, 2011 one night room rate including 21% tax & service charge will be charged.2. February 7th, 2011 two night room rate including 21% tax & service charge will be charged.3. Cancellations received after March 7th, 2011 or no-shows or early departure full rates of your stay including 21% tax & service charge will be charged.
If you would like to request a group booking, please send an e-mail to dr_�[email protected] the title: ISDS 2011 Group Booking (request to dr. Fitria) and provide; o Arrival/Departure Dates o Number of room/beds required o Number of Occupants o Three hotel preferences
GROUP BOOKING REQUEST
Late check out policy:Check in time: 14:00 Check out time: 12:00Late check-out must be arranged in advancewith the front o�ce. Any extra charge incurredwill be borne by the guest Payment forms:Visa, MasterCard, Cash
c/o CAS Congress Administration Services GmbHSeeheimer Str. 3D-64297 Darmstadt/GermanyPhone : +49 (0) 6151/10 123-0Fax : +49 (0) 6151/10 123-10e-mail : [email protected] USE OUR ONLINE REGISTRATION DESK 24 HOURS A DAY: www.isdsworld.com
1. ISDS Headquarters Darmstadt ( NON-INDONESIAN )
Dept. of Dermatovenereology, G3 Cempaka 2Dr. Cipto Mangunkusumo HospitalJl. Diponegoro 71 Jakarta 10430, IndonesiaContact person : dr. Jonathan R. SubektiO�ce Phone : 021-390 45 17 / 315 23 16 Fax : 021-316 11 33 / 390 45 17Email : [email protected] : http://ISDSBali2011.com
2. ISDS Secretariat Office ( INDONESIAN )
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The congress organizing committee and congress o�ce acts as an intermediary and is not responsible or liable for any medical expenses, loss, accidents or damages to people or things during the entire conference independently of their origin. Any other agreement will only be e�ective in writing and signed by both parties. Organizers cannot assume liability for any changes in the program due to external or unforeseen circumstances.
SPOUSES AND GUESTS
PLEASE WEAR YOUR BADGE!
No access into the Venue and Congress sessions will be allowed without wearing the badge. Attendees and their guests are required to pick up and wear their conference badges at all times throughout the meeting. This allows us to ensure that only our paid registrants are bene�ting from this educational opportunity and helps provide adequate security for your safety. Your badge color code also helps sta� of direct you to the meeting room location for which you are registered. If you misplace your badge, simply show your con�rmation letter or on-site payment receipt for a replacement badge.
CANCELLATION
PHOTO AND VIDEO SHOT ARE STRICTLYFORBIDDEN DURING THE ENTIRE MEETING
We will refund the complete registration fee with a 50,00 Euro processing fee if written cancellation reaches us before is March 7th 2011. We will refund 50 % of the total payment if written cancellation reaches us before is March 21st 2011. After this date no refund will be possible. No refund will be made for no-shows or early check-out date.
LIABILITY
Please send us your abstract as a word-�le (max.250 words) to: [email protected] / [email protected]. The deadline is February 28th 2011. With transmission of the abstract(s) you transfer the Copyright of the Abstract to The 3rd Spring Meeting of the International Society for Dermatologic Surgery, April 7-10, 2011 – who is authorized to publish it in print- or electronic medias.
It is always the Society’s pleasure to welcome the spouses and families of meeting registrants; however, each guest is required to purchase a special spouse badge in order to participate in any social event.
CONTINUING MEDICAL EDUCATION
The 3rd Spring Meeting of the International Society for Dermatologic Surgery will have Indonesian CME Accreditation awarded by the Indonesian Doctors Association/ Ikatan Dokter Indonesia (IDI).
CERTIFICATE OF ATTENDANCE
Participating delegates will receive a Certi�cate of Attendance.
REGISTRATION CONFIRMATION
Each attendee registered in advance will receive a con�rmation of registration by the congress o�ce. Please bring a copy of your registration con�rmation letter to on-site registration to speed up the process. If you do not have a con�rmation letter and there is no record payment receipt by the congress o�ce, you will be required to provide payment on-site, even if you think a payment was remitted previously. Any duplicate payment resulting will be resolved following the meeting.
ON-SITE REGISTRATION AND BADGE PICK-UP
The congress o�ce registration desk will be located Bali International Convention Centre. Please keep in mind that on-site-registration can be time consuming. Everyone is strongly encouraged to register prior to deadline in order to avoid delays, �lled courses and having to pay a higher registration fee. You are reminded to bring your con�rmation letter with you when you pick up your badge and meeting material. We recommend that attendees allow su�cient time to pick up their badges prior to the meeting, to avoid the last minute lines that may result in a missed session.
ABSTRACTS
Departemen Ilmu Kesehatan Kulit & Kelamin FKUI/RSCM G3, Cempaka 2Dr. Cipto Mangunkusumo HospitalJl. Diponegoro 71, Jakarta 10430, IndonesiaContact person : Dr. Tina Wardhani Wisesa, Sp.KK(K)O�ce Phone : 021-390 45 17 / 315 23 16 Fax : 021-316 11 33 / 390 45 17Email : [email protected] : http://ISDSBali2011.com
CAS Rosenparkklinik GmbHSilvia Becker / Karin SchaferSeeheimer Str. 364297 Darmstadt/GermanyPhone : +49 (0) 6151/10 123-0Fax : +49 (0) 6151/10 123-10Email : [email protected]
INDUSTRIAL EXHIBITION
Some countries require visa arrangement. Please contact the local Indonesian Embassy or Consulate in your country (Note: no visa required for ASEAN countries)
PASSPORT & VISA
Upon request, the Organizing Committee will issue a letter of invitation. The sole purpose of the letter is to facilitate the delegate’s travel and visa arrangements. The invitation does not imply provision of �nancial or other support.
LETTER OF INVITATION
The unit of currency is the Rupiah (IDR) and credit cards are accepted at most hotels and shops. Exchange rate approx. EUR 1 : Rp. 12.000,-. Porter’s tip at the airport is +/- IDR 10,000,- / luggage.provision of �nancial or other support.
CURRENCY
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OPTIONAL TOURS
On behalf of SARI BALI CONVEX and your conference organizers, we are delighted to welcome you to Bali-the island of God and known as the island with a thousand temples.
Bali is not only unique but also interesting to enjoy which is famous for its temples, its people, its culture and thousand varieties of local handicrafts to choose from. All bookings should be made 48 hrs in advance. For further information please contact our tour desk at the lobby.
HAVE A GREAT TIME IN BALI
RAFTINGExperience white water rafting along the river of Ayung in Ubud during your time in Bali.Sobek River RaftingForeigner USD 79Domestic Rp 350.000
GOLFLush 18-holes golf course is ready to challenged by you and with a group of friends.Bali Golf & Country Club18 holes USD 165Bali Handara Kosaido &Country Club18 holes USD 145
SUNSETCruise during the sunset and enjoy the gourmet bu�et with live entertainment.
Domestic Rp 374.000Foreigner USD 45
CRUISINGFull DayCruise to Lembongan Island, one of the famous attractions in Bali. Includes lunch, and beach activitiesBounty Cruises Domestic ForeignerAdult Rp 600.000 USD 79Child 4-14 Rp 300.000 USD 40
Bali Hai Beach Club Cruises Domestic ForeignerAdult Rp 748.000 USD 95Child 4-14 Rp 374.000 USD 48
WATERBOOM PARKExciting water slides slice through 3.5 hectares of landscaped tropical parks. Domestic ForeignerAdult Rp 180.000 USD 26Child 2-12 Rp 130.000 USD 16
JIMBARAN BAY DINNEREnjoy seafood BBQ dinner by the sea with the gentle ocean breeze and the sound of the waves, and starlight.Pandan Sari Cafe-JimbaranRp 200.000
SPAPamper yourself from head to toe and let the magic of our spa takes its natural course.Special Spa USD 60Origional Spa USD 30
Welcome to the islandof Paradise Bali.
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KINTAMANI TOUR(min. 5 person) Rp 450.000/person(08.00 am - 05.00 pm)ItineraryDepart from hotel to Batubulan to see barong performance, continue to Celuk for silver and gold jewelries continue to Kintamani to see beautiful Batur mountain and lake Batu while enjoy the Batur view. Lunch will be served at Lokal restaurant (included), Tegalalang for paddies terrace, continue to Ubud and stop at Sukawati Market to get souvenir to take home, back to Hotel.
CITY TOUR(min. 5 person) Rp 450.000/person(09.00 am - 03.00 pm)Itinerary
After breakfast you will visit the bali museum in Denpasar, continue to Monument Perjuangan Rakyat Bali in Renon, Denpasar to see the miniatur of Balinese History. Continue to Sanur as oldest tourism destination in Bali (pass by), Nusa Dua Area (pass by) Lunch to Lokal Restaurant, continue to GWK-Garuda Wisnu Kencana-tallest Garuda and Wisnu statue and to see Denpasar from the top. Last visit at Uluwatu Temple, bak to hotel.
BEDUGUL TOUR(min. 5 person) Rp 450.000/person(08.00 am - 05.00 pm)ItineraryDepart from hotel to Taman Ayun Temple-one of famous Balinese Royal Temple, Continue to Bedugul to see Lake Batur and Ulun Danu Temple, Lunch at Lokal Restaurant (included), than to Alas Kedaton to see Monkey habitat, continue to Tanah Lot for Sunset and Souvenir, back to Hotel.
BESAKIH TOUR(min. 5 person) Rp 600.000/person(08.00 am - 05.00 pm)Itinerary
Depart from hotel to Batubulan to see barong performance, continue to Celuk for silver and gold jewelries continue to Kintamani to see beautiful Batur mountain and lake Batu while enjoy the Batur view. Lunch will be served at Lokal restaurant (included). Continue to Mother Temple-BESAKIH to see beautiful, and interesting balinese temple architecture-Sukawati Market to get souvenir to take home, back to hotel.
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PLEASE CONTACT : SARI BALI CONVEX +62-361 744 36 38
CONTACT INFORMATION
Rp 2.500.000,- / € 230,-Rp 2.500.000,- / € 230,-Rp 2.500.000,- / € 230,-
Please use our online registration desk 24 hours a day: http://ISDSBali2011.com
or Fax this form to PERDOSKI Headquarters: 021-316 11 33 / 390 45 17
(registration main congress required)
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O O Rp 2.500.000,- / € 230,-
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APRIL 7-9, 2011
APRIL 6, 2011
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Name Title
Address
City State Zip Country
Phone Fax
CONGRESS REGISTRATION
PRE-CONGRESS-COURSES & WORKSHOPS
SCIENTIFIC SESSION
SOCIAL EVENT
EARLY BIRD AFTER FEBRUARY 21, 2011
EARLY BIRD AFTER FEBRUARY 21, 2011
08:00am – 12:30am A: The Aging Face and How to Manage08:00am - 12:30am B: Aging Body and Body Rejuvenation08:00am - 12:30am C: Learn how to do Dermatologic Surgery Limited to 100 Participants for each session
MASTER COURSE, APRIL 7, 2011
WORKSHOP, APRIL 10, 201108:00am – 12:00noon A: Liposuction12:00noon – 16:00pm B: Blepharoplasty08:00am – 12:00noon C: Autologous Fat Augmentation12:00noon – 16:00pm D: Flap SurgeryLimited to 50 Participants for each session
08:00am – 12:00noon E: Fillers (hands-on)12:00noon – 16:00pm F: Chemical Peeling (hands-on)08:00am – 12:00noon G: Botox Beginner (hands-on)12:00noon – 16:00pm H: Botox Advance (hands-on)Limited to 75 Participants for each session (hands on for the �rst 15 participants)
Rp 750.000,- / € 70,- Rp 750.000,- / € 70,-
O Rp 750.000,- / € 70,-
Rp 1.000.000,- / € 95,- Rp 1.000.000,- / € 95,-
O Rp 1.000.000,- / € 95,-
Rp 1.500.000,- / € 140,-Rp 1.500.000,- / € 140,-
Rp 1.500.000,- / € 140,-Rp 1.500.000,- / € 140,-
Rp 3.000.000,- / € 280,-Rp 3.000.000,- / € 280,-Rp 3.000.000,- / € 280,-
O O Rp 3.000.000,- / € 280,- O O O O O O
Rp 2.000.000,- / € 190,-Rp 2.000.000,- / € 190,-
Rp 2.000.000,- / € 190,-Rp 2.000.000,- / € 190,-
Rp 3.000.000,- / € 280,-Rp 2.000.000,- / € 190,-
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EARLY BIRD AFTER FEBRUARY 21, 2011Rp 3.500.000,- / € 320,-Rp 2.000.000,- / € 190,-
Rp 3.500.000,- / € 320,-Rp 2.500.000,- / € 230,-
Rp 5.000.000,- / € 460,-Rp 4.000.000,- / € 380,-
Rp 4.000.000,- / € 380,-Rp 3.000.000,- / € 280,-
Rp 1.000.000,- / € 95,-Rp 1.000.000,- / € 95,-
APRIL 7 & 10, 2011
RESIDENTincluding Industrial Exhibition, Morning Session, and Gala Dinner *(only applicable with a copy of a con�rmation of the the education hospital/practice)MEMBER ISDSincluding Industrial Exhibition, Morning Session, and Gala Dinner *NONMEMBERincluding Industrial Exhibition, Morning Session, and Gala Dinner *MEMBER PERDOSKIincluding Industrial Exhibition, Morning Session, and Gala Dinner *SPOUSE PASS including Industrial Exhibition and Gala Dinner*
GOLF TOURNAMENT, APRIL 6, 201108:00am – 17:00pm ISDS Golf TournamentLimited to 30 Participants
or FAX this form to ISDS Headquarters: +49-6151-1012310
NON-INDONESIAN
* Re-registration are required for: Morning sessions and Gala dinner.
Please contact 021-390 45 17 / 315 23 16
INDONESIAN
Please use our online registration desk 24 hours a day: www.isdsworld.com
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Hotel Room Category Number of persons Per night Arrival date/ departure date Subtotal
HOTEL ACCOMMODATION
WESTIN RESORT
THE GRAND BALI
GRAND HYATT
THE LAGUNA
INNA PUTRI BALI
NUSA DUA BEACH
NOVOTEL
Deluxe Room
Deluxe RoomPool Access RoomGrande RoomClub Ocean KingDeluxe Studio RoomGuest RoomDeluxe RoomSuperior RoomSuperior RoomDeluxe RoomDeluxe Room
2,100,000.- IDR
1,050,000.- IDR1,300,000.- IDR2,100,000.- IDR2,200,000.- IDR2,400,000.- IDR2,100,000.- IDR 950,000.- IDR 850,000.- IDR1,300,000.- IDR1,450,000.- IDR1,500,000.- IDR
Five nights package (April 6-10, 2011 ).
Please charge my credit card for payment of total : rupiah
O VISA O MasterCard O American Express
Card Number Expiration Date
Name on Card
Date
OR
Signature
O VISA O MasterCard O American Express
Card Number Expiration Date
Name on Card
Date Signature
PAYMENT FOR INDONESIAN TOTAL AMOUNT
PAYMENT FOR NON-INDONESIAN
Please charge my credit card for payment of total : ................Euro
I have transfered Rupiah to Mandiri BANK RSCM BranchAccount Name : ISDS BALI 2011Account Number : 122-00-05577518
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Name: Birthdate: First/Given Middle Last/Family Month Day Year
Category of Membership - Check one only: Fellow Associate ResidentFellow: Any physician who is licensed to practice medicine, currently performs dermatologic surgery and has completed three (3) years of post graduate training in dermatology. Associate: Any licensed physician who has at least one year, but less than three (3) years of post graduate training in dermatology or any licensed physician who has completed a one (1) year dermatologic surgery fellowship.
Resident : Any physician who is in an accredited dermatology residency or training program.
a ddress:
City: State/Province: Postal Code:
Country: E-mail a ddress:
Fax :
(Include Country/City Codes) (Include Country/City Codes)
Home a ddress:
City: State/Province: Postal Code:
Country: Home Phone: _________ (Inc Country/City Codes)
Please indicate how you learned about the ISDS: _____________________________________________________
Preferred Mailing a ddress - Check one: Home
n ame of Medical School: Year Completed Med School:
Specialty - Check one: Dermatology Other n umber of Yrs of Specialty Training:
Year Completed Specialty Training (i.e., 1984): Institution n ame:
Yes n
n
If you serve as a faculty member, identify your academic title:
n ame of Hospital or Institution where you serve as a faculty member:
Membership in Professional Societies:
The information below will provide the Society with information about the surgical procedures that you perform. Please check o� the procedures you perform, and the number of years experience with these procedures. General Dermatologic Surgery (Yrs. Exp. ) Vein Stripping (Yrs. Exp. ) Cryosurgery (Yrs. Exp. ) Hair Transplantation (Yrs. Exp. ) Mohs Surgery (Yrs. Exp. ) Skin Grafts & Flaps (Yrs. Exp. ) Cosmetic Surgery & Blepharoplasty (Yrs. Exp. ) Laser (Yrs. Exp. ) Male Genital Surgery (Yrs. Exp. ) Dermabrasion (Yrs. Exp. )
It is your responsibility to provide letters of recommendation from two (2) Fellows of the International Society for Dermatologic Surgery from your country. Contact the ISDS Headquarters if you require a list of the Fellows in your country or if your country does not have two ISDS Fellows.
Letters of recommendation have been requested from:
1) Name: 2) Name:
REVIEW INFORMATION BELOW AND SIGN APPLICATION FORM. Form will not be accepted without signature.• I understand that, if I am accepted for membership in the Society, payment of annual dues is required, beginning with the current year. Fellows, Associates, and
• I hearby waive any and all liabilit ication and arising out of said party’s membership in the ISDS.
• I understand a membership cert ).
Signature: Date: Send completed application, along with application fee, to: INTERNATIONAL SOCIETY FOR DERMATOLOGIC SURGERY
Silvia Becker, Str. 3, D-64297 Darmstadt – Germany Telephone: +49-6151-951 8892, FAX: +49-6151-951 8893, E-Mail: [email protected]
International Society for Dermatologic Surgery
Please enclose with application:1. Application Fee (non-refundable) e 20 2. Letters of recommendation
Payment in EUR must accompany application.INDICATE METHOD OF PAYMENT BELOW: Check enclosed, payable to ISDS MasterCard Visa American ExpressPrint card number in spaces below:
Expiration Date:
Signature:
APPLICATION FOR MEMBERSHIP
15
