REVISED

Announcement 3rd Spring Meeting of the International Society for Dermatologic Surgery (ISDS) in cooperation with: Indonesian Society of Dermatology & Venereology (PERDOSKI)

Bali/Indonesia

April 7-10, 2011 Bali International Convention Centre The Westin Resort, Nusa Dua Bali, Indonesia Cutting edge dermatologic surgery in the Island of Gods Congress President: Dr. Lis Surachmiati, Sp.KK, INDONESIA Program chairs: Atchima Suwanchinda M.D., THAILAND // Emily Piansay-Soriano M.D., PHILIPPINES// Kai Munte M.D. NETHERLANDS

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WELCOME TO INDONESIA ! 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, fillers, 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 office 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 field 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 MD Congress President

CONGRESS COMMITTEES PATRONS The 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).

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.KK Secretariat Coordinator Dr. Jonathan R. Subekti Treasurer Dr. Tina Wardhani Wisesa, Sp.KK(K) Vice treasurer Dr. Elisa Miranda, Sp.KK Fund 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.KK Sessions 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 1

Industrial exhibitions and ancillaries Dr. Eddy Karta, Sp.KK Dr. IGN Darmaputra, Sp.KK Scientific 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.KK Public relations Dr. Endi Novianto, Sp.KK Dr. Made Surdajana, Sp.KK Food and beverages Dr. Wieke Triestianawati, Sp.KK(K)

ISDS OFFICER ISDS OFFICERS PRESIDENT Jorge Ocampo Candiani, M.D.

President-Elect Joseph Alcalay, M.D.

Vice President

Henry W. Randle, MD, PhD, Professor

Treasurer

Loek Habbema, M.D.

Secretary

Anthony V. Benedetto, D.O., FACP

Historian

Diane I. Roseeuw, M.D.

Founder President Perry Robins, M.D.

Executive Director

C. William Hanke, MD, MPH, FACP Dr. med. Gerhard Sattler

Associate Executive Director Dr. med. Sonja Sattler

Immediate Past President Gary J. Brauner, M.D.

MEXICO ISRAEL USA NETHERLANDS USA BELGIUM USA USA GERMANY GERMANY USA

Board of Director Miriam Emily Piansay-Soriano, M.D. Dimitra Dasiou-Plakida, MD Doris Hexsel, M.D. Marina Landau, M.D. Mihaela Leventer, M.D. J. Ramsey Mellette, M.D. Kai Munte, M.D. Dr. med. Birgit Wörle Kevin S. Pinski, M.D. Maurizio Podda, MD, PhD Antonio Rusciani, M.D. Neil S. Sadick, MD, FACP, FAACS, FACPh

PHILIPPINES GREECE BRAZIL ISRAEL ROMANIA USA NETHERLANDS GERMANY USA GERMANY ITALY USA

INVITED FACULTY A AAGP Wiraguna Abraham Arimuko Agnes M. Espinoza-Thaebtharm Aida Suriadiredja Aileen Montero Alina Fratila Angela Cumagun Anis Irawan Anwar Anthony V. Benedetto Anthony Handoko Atchima Suwanchinda

B

Bambang Ratio Setiyarso

C

Claudine S. Roura Coen Gho Constantin Stan

D

Dewi Lestarini Dhiana Ernawati Adiprajog Doris Hexsel

INDONESIA INDONESIA PHILIPPINES INDONESIA PHILIPPINES GERMANY PHILIPPINES INDONESIA USA INDONESIA THAILAND INDONESIA PHILIPPINES NETHERLANDS ROMANIA INDONESIA INDONESIA BRAZIL

E

Eckart Haneke Edwin Djuanda Encarnation Legaspi Endang Sutedja Endra Yustin

GERMANY INDONESIA PHILIPPINES INDONESIA INDONESIA

FX. Hanny Suwandhany

INDONESIA

F

G

Gerhard Sattler Gunawan Budisantoso

H

GERMANY INDONESIA

Herman Cipto

INDONESIA

I.G.A. Sumedha Pindha Indah Handayani Indah Yulianto Danukusumo Ine Arline Diana Irma Bernadette Isabel Lopez Nazal

INDONESIA INDONESIA INDONESIA INDONESIA INDONESIA PHILIPPINES

I

J Jean D.A. Carruthers Jeffrey A. Klein

CANADA USA

K

S

Sabine Zenker Sahar Foad Ghannam Sandra Widaty Sjarief Hidayat Somesh Gupta Sonja Sattler Sri Aryani Sudharmono Sri Ellyani Sri Lestari Sudarto Oeiria Sudigdo Adi Susanti Budiamal Sutirto Basuki

GERMANY KUWAIT INDONESIA INDONESIA INDIA GERMANY INDONESIA INDONESIA INDONESIA INDONESIA INDONESIA INDONESIA INDONESIA

Tanja C. Fischer Teresia L.Toruan Teresita S. Ferrariz Thurakkal Salim Titi Lestari Sugito

GERMANY INDONESIA PHILIPPINES INDIA INDONESIA

T

W Welf Prager Wichai Hongcharu

Y

Yulia Faida Yahya

Kai Munte Kei Negishi Kimberly J. Butterwick

L

Lawrence Marshall Field Lili Legiawati Lilik Norawati Lis Surachmiati Suseno Lisa Donofrio

NETHERLANDS JAPAN USA USA INDONESIA INDONESIA INDONESIA USA

M Made Wardhana Maria Cristina Puyat Maria Isabel Mangubat Marina Landau Mark Michael Tanner Marwali Harahap Matthias Sandhofer Maurizio Podda Melania Sasongko Michael H. Gold Mihaela Leventer Miriam Emily Piansay-Soriano Mitchel Paul Goldman Moerbono Mochtar

N

Nicoletta Frasca Nugrohoaji Dharmawan

P

Petra Becker-Wegerich Prasetyadi Mawardi

R

R. Musliani Moestopo Raden Pamudji Remedios Manuel Remenda Siregar Reni Wiyakti Nanda Dewi Ronald L. Moy Roro Inge Ade Krisanti Roy Chio 2

INDONESIA PHILIPPINES PHILIPPINES ISRAEL GERMANY INDONESIA AUSTRIA GERMANY INDONESIA USA ROMANIA PHILIPPINES USA INDONESIA ITALY INDONESIA SWITZERLAND INDONESIA INDONESIA INDONESIA PHILIPPINES INDONESIA INDONESIA USA INDONESIA SINGAPORE

GERMANY THAILAND INDONESIA

TENTATIVE PROGRAM

Chair & Co-chair : Sandra Widaty (Indonesia), Bambang Ratio Setiyarso (Indonesia), R W Nanda Dewi (Indonesia), Edwin Djuanda (Indonesia), Gerhard Sattler (Germany)

DAY 1 - The Westin Resort Thursday, April 7th 2011

c . MASTER COURSE C (Jakarta Room) Learn how to do Dermatologic Surgery Lectures of 20’ each

7:30am - 8:00am

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) Dangerous zones in the face and neck How to do efficient skin biopsy // Mark Tanner (Germany) Flaps & Grafts: Nose Flaps & Grafts: Cheek // Jorge Ocampo-Candiani (Mexico) Flaps & Grafts: Orbital // Alina Fratila (Germany) Flaps and Grafts Oral Region Flaps and Grafts in nail surgery // Eckart Haneke (Germany) Suture techniques // Eckart Haneke (Germany) Wound healing management Surgical gems and pitfalls 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) Chair & Co-chair : Herman Cipto (Indonesia), Aida Suriadiredja (Indonesia), Marwali Harahap (Indonesia), Remenda Siregar (Indonesia), Eckart Haneke (Germany), Kai Munte (Netherlands)

REGISTRATION

8:00 - 12:30 noon a . MASTER COURSE A (Nusantara 2-3) The Aging Face and How to Manage Rejuvenate Lectures of 20’ each

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 face Alina 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 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) Chair & Co-chair : Aryani Sudharmono (Indonesia), Abraham Arimuko (Indonesia), Sudarto Oeiria (Indonesia), Sri Ellyani (Indonesia), Matthias Sandhofer (Austria),

10.00 - 10.30 am

12.30 - 13.30 am

LUNCH & EXHIBITION Exhibition Hall

13.30 - 14.30 am

OPENING CEREMONY & EXHIBITION PLENARY A (Nusantara 2-3 Room) 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)

14.30 - 16.00 am

a. SYMPOSIUM A (Nusantara 2-3 Room) Understanding acne and acne scar treatment

b. MASTER COURSE B ( Nusantara 1 Room ) Aging Body and Body Rejuvenation Lectures of 20’ each

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 tightening Laser 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)

COFFEE BREAK & EXHIBITION Exhibition Gallery & Nusantara Foyer

Lectures of 10’ each

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 scars Dermaroller 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 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) Chair & Co-chair : M. Yulianto Listiawan, Amaranila Lalita, Emily Soriano (Philippines), Sabine Zenker (Germany)

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 and possible complication and how to prevent)

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b. SYMPOSIUM B (Nusantara 1 Room) Phlebology & Sclerotherapy Lectures of 10’ each

Pathophysiology of venous insufficiency // Moerbono Mochtar (Indonesia) The role of superficial venous surgery in treatment of 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 Discussion group Varicous vein treatment(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) Chair & Co-chair : Paul Tahalele (Indonesia), Darwis Toena (Indonesia), Teresita Ferrariz (Philippines), Kai Munte (Netherlands) c. SYMPOSIUM C ( Jakarta Room ) What’s new in the treatment of pigmentation problems and melasma Lectures of 10’ each

Anatomy Pathophysiology Topical, 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 treatments Discussion group dyschromia treatment(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) Chair & Co-chair : Atchima Suwanchinda (Thailand), Kei Negishi (Jepang)

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DAY 2 - The Westin Resort Friday, April 8th 2011

11:30 - 12:30 pm a. FREE COMMUNICATION A (Nusantara 2-3 Room) Moderator: 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 definition Liposculpture, the next generation in bodysculpture // Claudine Roura (Phillipines) New Evolution Biotechnology Multiple Injections// Indah Yulianto (Indonesia)

07:15 - 08:00 pm a. MORNING SESSION A (Nusantara 2-3 Room) How to produce natural result with fat injection Autologous Fat Injection in Aesthetic Surgery Chair & Co-chair : Indah Yulianto (Indonesia) Sri Lestari (Indonesia) b. MORNING SESSION B (Nusantara 1 Room) Fractional lasers for rejuvenation Updates on fractional laser technology // Michael H. Gold (USA) Chair & Co-chair : Sudarto Oeiria (Indonesia), Susanti Budiamal (Indonesia)

b. FREE COMMUNICATION B (Nusantara 1 Room) Moderator: Marwali Harahap (Indonesia) 12:30 - 13:30 pm LUNCH & PRAYING Exhibition Hall

08:00 - 09:00 pm PLENARY B Current treatment options for managing male pattern baldness: How to Transplant for Maximal Result (30‘) My personal most efficient approach in hair transplantation // Coen Gho (Netherlands) Chair & Co-chair : Gunawan Budisantoso (Indonesia), AAGP Wiraguna (Indonesia) 09:00 - 11:00 pm a. SYMPOSIUM D (Nusantara 2-3 Room) Liposuction for cosmetic & non-cosmetic Indication

13:30 - 15:30 pm a. SYMPOSIUM F (Nusantara 2-3 Room) Stem cells therapy Stem cells and dermatologic surgery.Where are we now? // Sabine Zenker (Germany) Non Cultured Autologous Adipose-derived Stem cells therapy // Indah Yulianto (Indonesia) Paracrine Effect from Umbilical Cord Stem Cells for Anti Aging Therapy Stem cells in the management of acne scar repair Use of stem cells for Autologous Breast Augmentation// Roy chio (Singapure) Safety Confirmed of Breast Augmentation with Auotologous fat Stem Cells // Agnes M Espinoza (Philippines) Stem cells in management of venous insufficiency Stem cells Therapy Pitfalls and complications // Atchima Suwanchinda (Thailand) Discussion group Stem cell therapy, my first results(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 complicationand how to prevent)

Lectures of 10’ each

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 Lipedema Liposuction for Lipoma // Moerbono Mochtar (Indonesia) Autologous fat transfer to breast and buttocks, how to get long lasting results// Claudine Roua (Philippines) Liposuction in dangerous area// Lawrence M. Field (USA) Liposuction to assist Flaps and Grafts // Lawrence M. Field (USA) Lipofilling for Atrophic Skin Diseases // Lis Surachmiati (Indonesia) Lipofilling for dark eye circles // Gerhard Sattler (Germany) Complications in Liposuction// Guillermo Blugerman (Argentina) Discussion group Liposuction(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) Chair & Co-chair : Lis Surachmiati (Indonesia), Moerbono Mochtar (Indonesia) b. SYMPOSIUM E (Nusantara 1 Room) Surgical and Non-surgical approach for difficult skin problems

Chair & Co-chair : Indah Yulianto (Indonesia), Endra Yustin (Indonesia), Sudigdo Adi (Indonesia), Titi Lestari Sugito (Indonesia), Sabine Zenker (Germany), Atchima Suwanchinda (Thailand) b. SYMPOSIUM G (Nusantara 1 Room) Chemical peels that works When to use which Chemical Peel Chemical 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 first results(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) Chair & Co-chair : I.G.A. Sumedha Pindha (Indonesia), FX. Hanny Suwandhany (Indonesia), Marina Landau (Israel)

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 approach Non-facial skin fillers // 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 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 Chair & Co-chair : Lilik Norawati, Dhiana Ernawati (Indonesia) 11:00 - 11:30 pm COFFEE BREAK & EXHIBITION Exhibition Gallery & Nusantara Foyer

15:30 - 16:00 pm COFFEE BREAK & EXHIBITION Exhibition Gallery & Nusantara Foyer

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16:00 - 18:00 pm a. SYMPOSIUM H (Nusantara 2-3 Room) Reconstructive surgery for skin tumors Anatomy for tumor surgery // Maurizio Podda (Germany) Mohs Micrographic surgery // Ron Moy (USA) Tumor surgery of the ear Tumor surgery of the Lips Tumor surgery of the eye lids // Alina Fratila Tumor surgery of the nails // Eckart Haneke (Germany) Complications in tumor surgery Discussion group tumor surgery(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 complications and how to prevent) Chair & Co-chair : Herman Cipto (Indonesia), Made Wardhana (Indonesia), Mihaela Leventer (Romania), Roro Inge Ade Krisanti (Indonesia) b. SYMPOSIUM I (Nusantara 1 Room) Management of cellulite Anatomy and classification 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 effective are they? 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 after The international approach European – Asian – US – Middle East (Best treatment – My way of how I did it and possible complications and how to prevent) Chair & Co-chair : Raden Pamudji (Indonesia) , Doris Hexsel (Brazil), Michael Gold (USA) 19:00 pm

GALA DINNER

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DAY 3- The Westin Resort

Chair & Co-chair : Yulia Farida Yahya (Indonesia), Musliani Moestopo (Indonesia), Edwin Djuanda (Indonesia), Nugrohoaji Dharmawan (Indonesia)

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Saturday, April 9 2011 11:00 - 11:30 am a. MORNING SESSION C (Nusantara 2-3 Room) Flaps and grafts Flap and Graft in Difficult Facial Defect // Mihaela Leventer (Romania) Chair & Co-chair : Gunawan Budisantoso (Indonesia), Endang Sutedja (Indonesia) b. MORNING SESSION D (Nusantara 1 Room) Laser for vascular lesions Laser for Vascular lesions Chair & Co-chair : Irma Bernadette (Indonesia), Inne Arline Diana (Indonesia) 08:00 - 09:00 am PLENARY C (Nusantara 2-3 Room) Integrative medicine for rejuvenation: the future? (25`) // Achima Suwanchinda ( Thailand) The role of lasers and energy based devices in dermatologic surgery New approaches and devices for rejuvenation Face + Body(25´) Chair & Co-chair : Sudarto Oeiria (Indonesia), Indah Yulianto (Indonesia) 09:00 - 11:00 am a. SYMPOSIUM J (Nusantara 2-3 Room) Update on surgical management for pigmentary disorders 07:15 - 08:00 am

COFFEE BREAK & EXHIBITION Exhibition Gallery & Nusantara Foyer

11:30am-12:30pm a. FREE COMMUNICATION C (Nusantara 2-3 Room) Moderator b. FREE COMMUNICATION D (Nusantara 1 Room) Moderator: Kai Munte (Netherlands)

12:30 - 13:30 pm LUNCH & EXHIBITION Exhibition Hall 13:30 - 14:30 pm a. SYMPOSIUM L (Nusantara 2-3 Room) Surgical treatment options for non melanoma skin cancer (Mohs Surgery) Lectures of 10’ each

Lectures of 10’ each

Pathophysiology of Vitiligo Challenges in surgical management of vitiligo // Ronny Handoko (Indonesia) Autologous transplants in the management of vitiligo // Thurakkal Salim (India) Effectivity of excimer lasers in treatment of vitiligo // Bing Wibisono (Indonesia) Trends and visions in vitiligo therapy // Somesh Gupta (India) Complications in vitiligo therapy Discussion group cellulite(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 complications and how to prevent) Chair & Co-chair : Lili Legiawati (Indonesia), Somesh Gupta (India) b. SYMPOSIUM K (Nusantara 1 Room) Facial Rejuvenation, Face lift, Volume fillers, Volumetric Fillers, Fat, Botulinum toxin Lectures of 10’ each

Anatomy for botulinum toxin treatments and volume filling // Gerhard Sattler (Germany) How to choose the right dermal filler // Kimberly J. Butterwick (USA) Superficial filling and rejuvenation (Mesotherapy etc) // Nicoletta Frasca ( Italy) Platelet Rich Plasma helps tighten the facial skin? // Nicoletta Frasca (Italy) Botulinum toxin products which differences are there? // Welf Prager (Germany) The new filler generation: subdermal fillers ( Sculpta, Radiesse,highly linked HA) How to get the best in facial fat grafting// Lisa Donofrio Different techniques of volume filling Dark eye circles treatment with fillers or fat // Emily Soriano (Philippines) The perfect lip // Sahar Ghannam (Kuwait) Facelift or fat grafting When to add fractionated Lasersystems or RF devices for facial rejuvenation // Alina Fratila (Germany) Complications in filler and botulinum toxin treatments Discussion group: combined rejuvenation procedures(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 complications and how to prevent)

Mohs micrographic surgery How does it work? // Eckart Haneke (Germany) Pitfall of Mohs Micrographic Surgery in Dermatofibrosarcom Mohs Micrographic Surgery for SCC// Mihaela Leventer (Romania) Complications in Mohs micrographic surgery // Ron Moy (USA) Discussion group how to perform MOS in different parts of the world(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 complications and how to prevent) Chair & Co-chair : Herman Cipto (Indonesia), Remenda Siregar (Indonesia), Maurizio Podda (Germany), Ron Moy (USA) b. SYMPOSIUM M (Nusantara 1 Room) Surgical options for periorbital rejuvenation Lectures of 10’ each

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 area Rapid Technique of Oriental Upper Lid Blepharoplasty// Edwin Djuanda (Indonesia) Dark eye circle treatment options // Maria Cristina Puyat (Philippines) Classical Blepharoplasty // Alina Fratila (Germany) Discussion group my best case periorbital rejuvenation(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 complications and how to prevent) Chair & Co-chair : Sutirto Basuki (Indonesia) Dewi Lestarini (Indonesia), Anthony Handoko (Indonesia), Alina Fratila (Germany), Maria Cristina Puyat (Philippines) 15:30 - 16:00 pm COFFEE BREAK & EXHIBITION Exhibition Gallery & Nusantara Foyer 16:00 - 18:00 pm CLOSING CEREMONY (Nusantara 2-3 Room)

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DAY 4 - Sanglah hospital Sunday, April 10th 2011 08:00 - 12:00 noon

08:00 - 12:00 noon

12:00 noon -16:00 pm WORKSHOP F (Sanglah Hospital)

Chemical Peeling INSTRUCTOR : Marina Landau (Israel), Lili Supardiman (Indonesia), FX. Hanny Suwandhany (Indonesia) Abraham Arimuko (Indonesia) Co Instructor : Enny Widjaja (Indonesia) Laksmi Duarsa Irma Bernadette (Indonesia) WORKSHOP H (Sanglah Hospital) Botox Advance INSTRUCTOR : Jean D.A. Carruthers (Canada), Welf Prager (Germany), Maria Isabel Mangubat (Philippines) Co Instructor : Sri Ellyani (Indonesia) R W Nanda Dewi (Indonesia) Inne Arline Diana (Indonesia)

WORKSHOP A (Sanglah Hospital) Abdomen Lateral Upper Thigh Liposuction INSTRUCTOR : Emily Piansay-Soriano (Philippines), Sri Lestari (Indonesia), Guillermo Blugerman (Argentina) Co Instructor : Indah Yulianto (Indonesia) Sri Lestari (Indonesia) Emily Soriano (Philippines) Guillermo Blugerman (Argentina) WORKSHOP C (Operating Room Sanglah Hospital) Autologous Fat Augmentation INSTRUCTOR : Gerhard Sattler (Germany), Edwin Djuanda (Indonesia) Co Instructor : Gerhard Sattler (Germany) Edwin Djuanda (Indonesia) Moerbono Mochtar (Indonesia) Made Wardhana (Indonesia)

12:00 noon -16:00 pm WORKSHOP B (Operating Room Sanglah Hospital) Asian Blepharoplasty vs Caucasian Blepharoplasty INSTRUCTOR : Angeles de Leon, Alina Fratilla (Germany), Sudarto Oeiria (Indonesia), Agnes M. Espinoza (Philippines) Guillermo Blugerman (Argentina) Co Instructor : Angeles de Leon Alina Fratila (Germany) Susanti Budiamal (Indonesia) Sudarto Oeria (Indonesia) Anis Irawan Anwar (Indonesia) WORKSHOP D (Operating Room Sanglah Hospital) Flap Surgery 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 E (Sanglah Hospital) Fillers INSTRUCTOR : Maria Cristina Puyat (Philippines), Lis Surachmiati (Indonesia), Petra Becker Wegerich (Switzerland) Co Instructor :Lis Surachmiati (Indonesia) Maria Christina Puryat (Philippines) Melania Sasongko (Indonesia) Prasetyadi Marwadi (Indonesia) WORKSHOP G (Sanglah Hospital) Botox Beginner INSTRUCTOR : Isabel Mangubat (Philippines) Co Instructor : Atchima Suwanchinda (Thailand) R. Musliani Moestopo (Indonesia) Sri Ellyani (Indonesia) R W Nanda Dewi (Indonesia) Sjarief Hidayat (Indonesia)

8

GENERAL INFORMATION VENUE Bali International Convention Centre The Westin Resort Nusa Dua Bali 80363 Indonesia Phone: (62)(361) 771906 ISDS HOTEL RATES 2011 WESTIN, NUSA DUA BALI Deluxe Room : Rp.2.100.000

THE GRAND BALI, NUSA DUA BALI Deluxe Room : Rp.1.050.000 Pool Acces Room : Rp.1.300.000 THE LAGUNA, NUSA DUA BALI Deluxe Studio Room : Rp.2.400.000 Guest Room : Rp.2.100.000 GRAND HYATT, NUSA DUA BALI Grand King : Rp.2.100.000 Club Ocean King : Rp.2.200.000 INNA PUTRI BALI, NUSA DUA BALI Deluxe Room : Rp.950.000/nett Superior Room : Rp.850.000/nett NUSA DUA BEACH, NUSA DUA BALI Superior Room : Rp.1.300.000 Deluxe Room : Rp.1.450.000 NOVOTEL, NUSA DUA BALI Deluxe Room : Rp.1.500.000/nett

HOTEL ACCOMMODATIONS AND RESERVATIONS The Organizing Committee has appointed the Sari Bali Convex as the Official 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 offer the most convenient and efficient accommodation service. To make a hotel reservation, please use our secure on-line registration system. Please visit official website : http://ISDSBali2011.com

DEPOSIT POLICY o A valid credit card is required by the PCO to confirm 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 confirm 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. * 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

WHEN TO BOOK A ROOM 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 first come first served basis. Hotel rooms will be in extremely high demand in April 2011 so we encourage you to make reservations as early as possible.

9

GROUP BOOKING REQUEST If you would like to request a group booking, please send an e-mail to [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 Late check out policy: Check in time: 14:00 Check out time: 12:00 Late check-out must be arranged in advance with the front office. Any extra charge incurred will be borne by the guest Payment forms: Visa, MasterCard, Cash REGISTRATION 1. ISDS Headquarters Darmstadt ( NON-INDONESIAN ) c/o CAS Congress Administration Services GmbH Seeheimer Str. 3 D-64297 Darmstadt/Germany Phone : +49 (0) 6151/10 123-0 Fax : +49 (0) 6151/10 123-10 e-mail : [email protected] PLEASE USE OUR ONLINE REGISTRATION DESK 24 HOURS A DAY: www.isdsworld.com 2. ISDS Secretariat Office ( INDONESIAN ) Dept. of Dermatovenereology, G3 Cempaka 2 Dr. Cipto Mangunkusumo Hospital Jl. Diponegoro 71 Jakarta 10430, Indonesia Contact person : dr. Jonathan R. Subekti Office Phone : 021-390 45 17 / 315 23 16 Fax : 021-316 11 33 / 390 45 17 Email : [email protected] Website : http://ISDSBali2011.com OFFICAL LANGUAGE IS ENGLISH

SPOUSES AND GUESTS 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 Certificate of Attendance. REGISTRATION CONFIRMATION Each attendee registered in advance will receive a confirmation of registration by the congress office. Please bring a copy of your registration confirmation letter to on-site registration to speed up the process. If you do not have a confirmation letter and there is no record payment receipt by the congress office, 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 office 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, filled courses and having to pay a higher registration fee. You are reminded to bring your confirmation letter with you when you pick up your badge and meeting material. We recommend that attendees allow sufficient time to pick up their badges prior to the meeting, to avoid the last minute lines that may result in a missed session.

PHOTO AND VIDEO SHOT ARE STRICTLY FORBIDDEN DURING THE ENTIRE MEETING LIABILITY The congress organizing committee and congress office 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 effective in writing and signed by both parties. Organizers cannot assume liability for any changes in the program due to external or unforeseen circumstances. ABSTRACTS Please send us your abstract as a word-file (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. CURRENCY 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 financial or other support.

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 benefiting from this educational opportunity and helps provide adequate security for your safety. Your badge color code also helps staff of direct you to the meeting room location for which you are registered. If you misplace your badge, simply show your confirmation letter or on-site payment receipt for a replacement badge.

PASSPORT & VISA Some countries require visa arrangement. Please contact the local Indonesian Embassy or Consulate in your country (Note: no visa required for ASEAN countries)

LETTER OF INVITATION 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 financial or other support.

CANCELLATION 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.

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INDUSTRIAL EXHIBITION Departemen Ilmu Kesehatan Kulit & Kelamin FKUI/RSCM G3, Cempaka 2 Dr. Cipto Mangunkusumo Hospital Jl. Diponegoro 71, Jakarta 10430, Indonesia Contact person : Dr. Tina Wardhani Wisesa, Sp.KK(K) Office Phone : 021-390 45 17 / 315 23 16 Fax : 021-316 11 33 / 390 45 17 Email : [email protected] Website : http://ISDSBali2011.com CAS Rosenparkklinik GmbH Silvia Becker / Karin Schafer Seeheimer Str. 3 64297 Darmstadt/Germany Phone : +49 (0) 6151/10 123-0 Fax : +49 (0) 6151/10 123-10 Email : [email protected]

OPTIONAL TOURS Welcome to the island of Paradise Bali. 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 RAFTING

Experience white water rafting along the river of Ayung in Ubud during your time in Bali.

Sobek River Rafting Foreigner Domestic

USD 79 Rp 350.000

GOLF

Lush 18-holes golf course is ready to challenged by you and with a group of friends.

Bali Golf & Country Club 18 holes

USD 165

Bali Handara Kosaido & Country Club 18 holes

USD 145

SUNSET

CRUISING

Full Day Cruise to Lembongan Island, one of the famous attractions in Bali. Includes lunch, and beach activities Bounty Cruises Domestic Foreigner Adult Rp 600.000 USD 79 Child 4-14 Rp 300.000 USD 40

Bali Hai Beach Club Cruises Adult Child 4-14

Domestic Rp 748.000 Rp 374.000

WATERBOOM PARK

Exciting water slides slice through 3.5 hectares of landscaped tropical parks. Domestic Foreigner Adult Rp 180.000 USD 26 Child 2-12 Rp 130.000 USD 16

JIMBARAN BAY DINNER

Enjoy seafood BBQ dinner by the sea with the gentle ocean breeze and the sound of the waves, and starlight.

Pandan Sari Cafe-Jimbaran Rp 200.000

SPA

Pamper yourself from head to toe and let the magic of our spa takes its natural course. Special Spa USD 60 Origional Spa USD 30

Cruise during the sunset and enjoy the gourmet buffet with live entertainment. Domestic Foreigner

Foreigner USD 95 USD 48

Rp 374.000 USD 45 11

BEDUGUL TOUR

(min. 5 person) Rp 450.000/person (08.00 am - 05.00 pm) Itinerary Depart 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

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.

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.

KINTAMANI TOUR

(min. 5 person) Rp 450.000/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), Tegalalang for paddies terrace, continue to Ubud and stop at Sukawati Market to get souvenir to take home, back to Hotel.

PLEASE CONTACT : SARI BALI CONVEX +62-361 744 36 38 12

CONGRESS REGISTRATION INDONESIAN Please use our online registration desk 24 hours a day: http://ISDSBali2011.com Please contact 021-390 45 17 / 315 23 16 or Fax this form to PERDOSKI Headquarters: 021-316 11 33 / 390 45 17

NON-INDONESIAN

Please use our online registration desk 24 hours a day: www.isdsworld.com or FAX this form to ISDS Headquarters: +49-6151-1012310 CONTACT INFORMATION CO Name

Title

Address City

State

Zip

Phone

Country

Fax

E-Mail

PRE-CONGRESS-COURSES & WORKSHOPS

(registration main congress required)

APRIL 7 & 10, 2011 EARLY BIRD

AFTER FEBRUARY 21, 2011

A: The Aging Face and How to Manage B: Aging Body and Body Rejuvenation C: Learn how to do Dermatologic Surgery

O O O

Rp 750.000,- / € 70,Rp 750.000,- / € 70,-

O O O

08:00am – 12:00noon 12:00noon – 16:00pm 08:00am – 12:00noon 12:00noon – 16:00pm

A: Liposuction B: Blepharoplasty C: Autologous Fat Augmentation D: Flap Surgery

O O O O

Rp 1.500.000,- / € 140,Rp 1.500.000,- / € 140,-

O O Rp 1.500.000,- / € 140,- O Rp 1.500.000,- / € 140,- O

Rp 2.500.000,- / € 230,Rp 2.500.000,- / € 230,Rp 2.500.000,- / € 230,Rp 2.500.000,- / € 230,-

08:00am – 12:00noon 12:00noon – 16:00pm 08:00am – 12:00noon 12:00noon – 16:00pm

E: Fillers (hands-on) F: Chemical Peeling (hands-on) G: Botox Beginner (hands-on) H: Botox Advance (hands-on)

O O O O

Rp 2.000.000,- / € 190,Rp 2.000.000,- / € 190,-

O O Rp 2.000.000,- / € 190,- O Rp 2.000.000,- / € 190,- O

Rp 3.000.000,- / € 280,Rp 3.000.000,- / € 280,Rp 3.000.000,- / € 280,Rp 3.000.000,- / € 280,-

MASTER COURSE, APRIL 7, 2011 08:00am – 12:30am 08:00am - 12:30am 08:00am - 12:30am

Limited to 100 Participants for each session

Rp 750.000,- / € 70,-

Rp 1.000.000,- / € 95,Rp 1.000.000,- / € 95,Rp 1.000.000,- / € 95,-

WORKSHOP, APRIL 10, 2011

Limited to 50 Participants for each session

Limited to 75 Participants for each session (hands on for the first 15 participants)

SCIENTIFIC SESSION

APRIL 7-9, 2011

O RESIDENT

O

O MEMBER ISDS

including Industrial Exhibition, Morning Session, and Gala Dinner *

O

Rp 2.500.000,- / € 230,-

O

Rp 3.500.000,- / € 320,-

O NONMEMBER

including Industrial Exhibition, Morning Session, and Gala Dinner *

O

Rp 4.000.000,- / € 380,-

O

Rp 5.000.000,- / € 460,-

O MEMBER PERDOSKI

including Industrial Exhibition, Morning Session, and Gala Dinner *

O

Rp 3.000.000,- / € 280,-

O

Rp 4.000.000,- / € 380,-

O SPOUSE PASS including Industrial Exhibition and Gala Dinner*

O

Rp 1.000.000,- / € 95,-

O

Rp 1.000.000,- / € 95,-

SOCIAL EVENT

APRIL 6, 2011

GOLF TOURNAMENT, APRIL 6, 2011

O

including Industrial Exhibition, Morning Session, and Gala Dinner * (only applicable with a copy of a confirmation of the the education hospital/practice)

* Re-registration are required for: Morning sessions and Gala dinner.

08:00am – 17:00pm Limited to 30 Participants

EARLY BIRD AFTER FEBRUARY 21, 2011 Rp 2.000.000,- / € 190,- O Rp 3.000.000,- / € 280,-

EARLY BIRD AFTER FEBRUARY 21, 2011 Rp 2.000.000,- / € 190,- O Rp 3.500.000,- / € 320,-

ISDS Golf Tournament

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HOTEL ACCOMMODATION Hotel

Room Category

WESTIN RESORT

O

Deluxe Room

2,100,000.- IDR

__-__ /__ /__

THE GRAND BALI

O O O O O O O O O O O

Deluxe Room Pool Access Room Grande Room Club Ocean King Deluxe Studio Room Guest Room Deluxe Room Superior Room Superior Room Deluxe Room Deluxe Room

1,050,000.- IDR 1,300,000.- IDR 2,100,000.- IDR 2,200,000.- IDR 2,400,000.- IDR 2,100,000.- IDR 950,000.- IDR 850,000.- IDR 1,300,000.- IDR 1,450,000.- IDR 1,500,000.- IDR

__-__ /__ /__ __-__ /__ /__ __-__ /__ /__ __-__ /__ /__ __-__ /__ /__ __-__ /__ /__ __-__ /__ /__ __-__ /__ /__ __-__ /__ /__ __-__ /__ /__ __-__ /__ /__

Five nights package (April 6-10, 2011 ).

GRAND HYATT THE LAGUNA INNA PUTRI BALI NUSA DUA BEACH NOVOTEL

Number of persons

Per night

PAYMENT FOR INDONESIAN

Arrival date/ departure date

TOTAL AMOUNT

Rupiah to Mandiri BANK RSCM Branch Account Name : ISDS BALI 2011 Account Number : 122-00-05577518

I have transfered

OR

Please charge my credit card for payment of total :

O

VISA

O

MasterCard

O

rupiah

American Express Expiration Date

Card Number Name on Card

Signature

Date PAYMENT FOR NON-INDONESIAN

Please charge my credit card for payment of total : ................Euro O

VISA

O

MasterCard

O

American Express Expiration Date

Card Number Name on Card

Signature

Date

14

Subtotal

Payment in EUR must accompany application. INDICATE METHOD OF PAYMENT BELOW:  Check enclosed, payable to ISDS  MasterCard  Visa  American Express Print card number in spaces below:

International Society for Dermatologic Surgery Expiration Date: Please enclose with application: 1. Application Fee (non-refundable) e 20 2. Letters of recommendation

Signature:

APPLICATION FOR MEMBERSHIP Name:

Birthdate:

First/Given

Middle

Last/Family

Category of Membership - Check one only:

Month Day Year

 Fellow

 Associate



 Resident

Fellow: 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:

Country:

Postal Code:

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: Specialty - Check one:

Year Completed Med School:

 Dermatology  Other

Year Completed Specialty Training (i.e., 1984):

 Yes

n umber of Yrs of Specialty Training: Institution n ame:

 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 off 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 and arising out of said party’s membership in the ISDS. I understand a membership cert

•

ication ).

Signature: Send completed application, along with application fee, to:

Date: 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] 15