"Temporal MORE (Modified Orbicularis REpositioning): going beyond the limits of temporal lifting".

BACKGROUND: Periorbital rejuvenation is often challenging and requires comprehensive evaluation of its various components to obtain satisfying results. Considering the crucial role of the orbicularis muscle in the periorbital aging process, the first author recently described his personal technique for temporal lifting through a subcutaneous approach in conjunction with an orbicularis muscle flap. In the current article, the authors present a modified and extended temporal lift approach, which allows for remarkable improvement not only in the temporal and brow region, but in the whole periorbital area up to the malar region, therefore named "Temporal MORE" (Modified Orbicularis REpositioning). METHODS: 212 consecutive patients underwent Temporal MORE by the same surgeon between May 2021 and September 2022. Each patient filled a FACE-Q© questionnaire preoperatively and 12 months postoperatively. 5 independent surgeons were asked to score the results evaluating patients' preoperative and postoperative pictures. RESULTS: No major complications were recorded. The most satisfying aspect of this technique was dramatic periorbital rejuvenation noticeable in all patients.FACE-Q pre-operative score was 34.29±5.872, while the post-operative was 80.11±6.796 (p<0.05); delta (post-pre) mean value was 45.82±8.925. Surgeons' questionnaire mean value was 41.92±6.010. Statistical analysis showed a strong correlation between surgeons' and patients' satisfaction ("r" value 0.7488). CONCLUSIONS: Temporal MORE proved to achieve a comprehensive rejuvenation of the periorbital area in a straightforward and reproducible way, with a fast recovery and a low complication rate. In this cohort, patient satisfaction with the result was remarkable and comparable to the judgment of the surgeons interviewed.

Fresh Frozen, In-Alcohol, or Autologous Costal Cartilage? Analysis of Complications in Over 650 Revision Rhinoplasties.

BACKGROUND: When there is insufficient autologous septal cartilage for graft sculpting in revision rhinoplasty, valid alternatives need to be found. Both autologous and homologous costal cartilage usage has been described in the literature. As there is no universally accepted consensus on cartilage choice, experience with different types of cartilage assumes significant importance in the rhinoplasty learning process. OBJECTIVES: This multicenter prospective study outlined an overview of the authors' experience regarding short-term and long-term complications following revision rhinoplasty procedures in which either fresh frozen (FFCC), in-alcohol (IACC), or autologous costal cartilage (ACC) was used. METHODS: A total of 671 patients undergoing revision rhinoplasty between June 2015 and September 2020 were divided into 3 groups according to the type of cartilage used (Group 1, 212 patients with FFCC; Group 2, 239 patients with IACC; Group 3, 202 patients with ACC). Sociodemographic and clinical characteristics and short- and long-term complications were described and discussed. A statistical analysis investigating a possible significance of the differences in complication rates was conducted. RESULTS: The data obtained indicated a short-term general complication rate of 5.05%, and a long-term complication rate of 7.04%. A statistically significant difference was identified in cartilage warping rate between the homologous cartilages in comparison to ACC. CONCLUSIONS: FFCC, IACC, and ACC can be safely used in revision rhinoplasty with no statistically significant differences regarding short- and long-term complication rates. Cartilage warping rate is significantly higher for ACC compared with FFCC and IACC.

Letter in reply to Letter to the Editor: Fat injection as a valuable tool for lower eyelid retraction management: a retrospective, observational, single blind, case-control study.

DEAR EDITOR: We have read Dr Riccardo Fondrini and Colleagues commentary on our paper, and we are grateful for their remarks. We herewith would clarify the critical points mentioned about fat reabsorption and survival, along with the risk of periorbital chronic oedema as per the recorded outcomes in the presented case series. Lastly, we have unfortunately to disagree with the commentary's point related to recommended injection depth as it is mandatory to point out that in our experience the superficial injection of nano-fat is a crucial step for lower eyelid retraction management, otherwise a retraction may persist due to the untreated scar in the anterior lamella, thus missing the therapeutic goal that we aim to achieve. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Fat Injection as a Valuable Tool for Lower Eyelid Retraction Management: A Retrospective, Observational, Single Blind and Case-Control Study.

BACKGROUND: The aim of this study was to evaluate the use of autologous fat graft injection to correct lower eyelid position METHODS: A retrospective, observational, single blind, case-control study was carried out on 94 patients, presenting with lower eyelid retraction in 159 eyes. In the sub-population with monolateral eyelid retraction, the not affected site has been considered as a control and compared with the outcomes recorded after treatment of the contralateral side Follow-up at 12 months was performed with a subjective assessment carried out by a questionnaire administered to patients while objective result assessment was performed 12 months after surgery by two independent blind examiners. RESULTS: The eyelid upward reposition has improved one year after fat grafting in both bilateral (1,52 mm) and unilateral (1,7 mm) population: the latter allowed to statistically validate (P<0.05) the result with respect to the not affected site. CONCLUSIONS: This is the first paper that highlights the outcomes of sole fat injection in the treatment of lower eyelid retraction: blind objective evaluation of surgical outcomes along with a patient assessment of both functional and aesthetic improvement one year after surgery confirm its efficacy and reliability along with the first case/control outcome evaluation of the technique carried on in the sub-population of 29 patients affected by unilateral lower eyelid retraction that validate the average improvement of the retracted eyelid one year after fat grafting as statistically significant. Nevertheless, longer follow-up periods and a larger sample size are needed to thoroughly confirm surgical outcomes and statistical results. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Orbital bone fractures: 10 years' experience at the Rome trauma centre: retrospective analysis of 543 patients.

Orbital fractures are among the most frequent facial traumas. This study retrospectively analysed patients treated in Umberto I Hospital Trauma-Centre, Sapienza University of Rome from 1 January 2010 to 31 December 2020. The inclusion criteria were as follows: diagnosis of pure/impure orbital bone fracture, complete clinical and radiological records, and a minimum 12-month follow up. Gender, age, aetiology, fracture type, treatment, and associated complications were analysed using IBM SPSS Statistics, and p values of <0.05 were considered significant. In total, 1393 patients presented with orbital trauma, 543 of whom met the inclusion criteria and underwent surgery (394 males (72.6%) and 149 females (27.4%); mean (range) age 39.2 (7-90) years). Assault (n = 165, 30.4%) was the most common cause of trauma, followed by road traffic accidents and sports-related incidents. Diplopia was the major symptom at diagnosis (n = 183, 33.6%). Open reduction and internal fixation via a sub-eyelid approach was the preferred treatment, achieving a significant reduction in the functional changes induced by fracture (p < 0.05). Our data will aid future studies of maxillofacial traumatology and suggest that education and prevention measures could reduce the incidence of this type of trauma.

The Rhino-Lip-Lifting: A Novel Proposal for Midface Profileplasty Performed as a Single Surgical Procedure.

As facial aging occurs, aesthetic changes of the nasal tip and the senile upper lip include tip ptosis, increase in skin length, loss of vermillion height and Cupid's bow, and vertical wrinkles.Regardless of the rejuvenation procedure, the lips are not to be considered as a single anatomical entity, instead they should be placed in a strong correlation with the nose. The aim of this study is therefore to demonstrate the effectiveness of the association of primary closed rhinoplasty together with indirect subnasal lip-lifting technique.A total of 45 patients were enrolled in this study and underwent primary closed rhinoplasty with indirect subnasal lip-lifting. The result showed an overall average nasolabial angle width reduction of 10.9% and lip length shortening of 23.5%, as assessed 1 year after the surgical procedure. When comparing before and after photographs and using the Subjective Global Aesthetic Improvement Scale (sGAIS), the overall satisfaction was rated 4.4 on 5, as "much improved."The authors show that lips should not be considered as a single anatomical entity but that they indeed must be placed in a strong correlation with the nose since a droopy nasal tip is likely to be considered unattractive and is often associated with the appearance of a long nose with covered philtrum and upper lip.Tip rotation to a normal nasolabial angle width could grant a beneficial impact on overall nose aesthetics; however, it may not fully balance the midface profile as it is the "lip position-to-incisal show" ratio that defines beauty, whereas the balance among forehead, nasal tip, upper lip, and chin is what defines the contour of harmonious profiles.This is the first patient series to show that the combination of closed rhinoplasty and indirect lip-lifting is a highly effective, safe, and reliable procedure to address profile rejuvenation.

Breast cancer patients with hormone neoadjuvant bridging therapy due to asymptomatic Corona virus infection. Case report, clinical and histopathologic findings.

INTRODUCTION: Breast cancer management during COVID-19 pandemic has changed and in case of COVID-19 patients with simultaneous neoplasia, it has been strongly recommended to treat Sars-CoV-2 infection firstly. PRESENTATION OF CASE: We reported a case of a 53-years-old women with early breast cancer and simultaneous asymptomatic SARS-CoV-2 infection. According to COVID-19 breast cancer recommendations she underwent hormone neoadjuvant treatment as a bridging therapy for surgery. Six months from the diagnosis, after virus eradication, patient underwent breast surgery. No SARS-CoV-2 RNA was found both in the surgical specimen and sentinel lymph node but micrometastasis were reported. During the last follow-up, the patient was in good clinical condition and started the adjuvant chemotherapy. DISCUSSION: COVID-19 outbreak determined the publication of temporary recommendation leading to an extensive use of neoadjuvant chemotherapy in breast cancer patients. Although endocrine therapy is a mainstay in the adjuvant treatment, its role in the neoadjuvant schedule is unclear. CONCLUSION: Upfront awake surgery should be preferred especially in asymptomatic COVID-19 patient with early breast cancer when monitoring of tumor response is not feasible.