Single-Step Full-Face Surgical Treatment of the Facial Profile.

The present study was performed to describe how much affordable, feasible, and straightforward is the approach the authors called "single-stage full-face surgical profileplasty," tailored to greatly improve the surgery of the facial profiling setting and achieve complete profile correction at the same time. From January 2010 to May 2019, 113 patients (95 females and 18 males; aged 19 - 63 years) were surgically treated for full-face profile amelioration. Profile correction was performed by using a combination of five procedures out of other various previously experienced: forehead fat grafting, rhinoplasty, lip fat grafting, genioplasty, and submental liposuction. All patients were assessed at 1, 3, 6, and 12 months following surgery for assessing the surgical profile treatment (SPT) outcome and any possible side effects of the combined treatment. Facial profile stability at 1 year was taken as the completion point of this treatment. Arnett et al's "Soft Tissue Cephalometric Analysis" (1999) was used to clinically evaluate the soft tissues before and after the SPT. Patients' satisfaction was measured with the Client Satisfaction Questionnaire-8" at 3 and 12 months after surgery. Statistics were used for Arnett et al's evaluation. Almost all the values were consistent and reached the normal ranges indicated by Arnett et al (p < 0.001), confirming that the desired results of the surgical profileplasty have been achieved. Single-stage full-face surgical profile treatment helps in correcting faults of the global facial deformity, in every single treated area, providing an overall improvement in facial aesthetics and harmony. Obtaining the simultaneous correction in the whole face has also the advantage of avoiding multiple surgical procedures, reducing postoperative discomfort, and the overall risks for the patient due to multiple surgical and anesthetic procedures.

Role of Robotics in Neuromodulator and Filler Injections of Face.

In recent years, robots have been increasingly used in various fields of medicine, including surgery, dentistry, and ophthalmology. One of the newest and most promising applications of robotic technology in medicine is in the field of facial aesthetics, particularly in the injection of facial fillers and neuromodulators. While facial injections have traditionally been performed manually by trained physicians and nurses, the introduction of robots has the potential to revolutionize the field, offering a range of potential benefits, including increased precision, accuracy, and consistency of results. However, the significant disadvantages of robots are high cost, lack of flexibility and personal touch, limited experience, and risk of injury due to malfunction.

Artificial Intelligence Versus Expert Plastic Surgeon: Comparative Study Shows ChatGPT "Wins" Rhinoplasty Consultations: Should We Be Worried?

Introduction: Large language models, such as ChatGPT, hold tremendous promise to bridge gaps in patient education and enhance the decision-making resources available online for patients seeking nasal surgery. Objective: To compare the performance of ChatGPT in answering preoperative and postoperative patient questions related to septorhinoplasty. Methods: Two sets of responses were collected for the questions: one from an expert rhinoplasty surgeon with over two decades of experience, and the other from ChatGPT-3.5. Seven expert rhinoplasty surgeons, blinded to the source of responses, independently assessed the responses using a 5-point Likert scale in four performance areas: empathy, accuracy, completeness, and overall quality. Results: ChatGPT outperformed physician responses in three of the four performance areas, earning significantly higher ratings in accuracy, completeness, and overall quality (p < 0.001). In addition, ChatGPT was overwhelmingly preferred over physician responses (p < 0.001), with evaluators favoring ChatGPT in 80.95% of instances. Conclusions: ChatGPT has demonstrated its remarkable ability to deliver accurate, complete, and high-quality responses to preoperative and postoperative patient questions. Although certain improvements are warranted, this artificial intelligence tool has shown its potential to effectively counsel and educate prospective septorhinoplasty patients at a level comparable with or exceeding that of an expert surgeon.

Influence of Surgical Technique on Post-Operative Complications in the Extraction of the Lower Third Molar: A Retrospective Study.

The surgical extraction of the impacted third molar is frequently associated with several complications. The purpose of this study is to assess how two different surgical protocols affect post-operative complications during the extraction of the lower impacted third molars. In order to compare and evaluate two different techniques (triangular flap vs. envelope flap), and the relative post-extraction complications, two groups of 150 patients each underwent to surgical impacted third molar extraction and 60 days of follow-up. The complication rate in the two groups was 14.00% in group A and 17.33% in group B. There was a strong association between smoking (OR: 2.8) and the use of oral contraceptives (OR: 1.75) with complications. The age- and sex-related incidence of complications in hard tissue healing has great variability in the literature; the analysis performed on our data did not show a statistically significant association between them. Even though related to a higher incidence of transient changes in sensitivity, it was found that the envelope flap saw a lower percentage of complications. There is still no clarity on which is the best protocol for the extraction of the lower impacted third molar, and the choice often depends on the surgeon's experience.

Histology and Long-term Clinical Outcome of Crushed Cartilage with Double-layer Gelatin Sponge Membrane for Dorsum Refinement in Primary Rhinoplasty.

This article demonstrates the ability to use autologous crushed cartilage grafts in rhinoplasty with rapid recovery and optimal nasal functionality without any tissue damage and allows its rapid rejuvenation. Eligible patients underwent primary rhinoplasty using autologous crushed cartilage graft followed by microscopy imaging of the grafted tissue after recovery. Tissue and cytological analysis using optical microscopy, transmission electronic microscopy (TEM), and scanning electronic microscopy (SEM) showed complete viability of chondrocytes, formation of new collagen fibers, neo-perichondrium, neo-angiogenesis, and exhibiting optimal aesthetic outcome. The surgical approach is easy to perform, feasible, and less time-consuming, with excellent tissue rejuvenation and rapid recovery.

Insights on the role of L-lactate as a signaling molecule in skin aging.

L-lactate is a catabolite from the anaerobic metabolism of glucose, which plays a paramount role as a signaling molecule in various steps of the cell survival. Its activity, as a master tuner of many mechanisms underlying the aging process, for example in the skin, is still presumptive, however its crucial position in the complex cross-talk between mitochondria and the process of cell survival, should suggest that L-lactate may be not a simple waste product but a fine regulator of the aging/survival machinery, probably via mito-hormesis. Actually, emerging evidence is highlighting that ROS are crucial in the signaling of skin health, including mechanisms underlying wound repair, renewal and aging. The ROS, including superoxide anion, hydrogen peroxide, and nitric oxide, play both beneficial and detrimental roles depending upon their levels and cellular microenvironment. Physiological ROS levels are essential for cutaneous health and the wound repair process. Aberrant redox signaling activity drives chronic skin disease in elderly. On the contrary, impaired redox modulation, due to enhanced ROS generation and/or reduced levels of antioxidant defense, suppresses wound healing via promoting lymphatic/vascular endothelial cell apoptosis and death. This review tries to elucidate this issue.

A Systematic Review and Meta-Analysis of Rhinoplasty Using the Rhinoplasty Outcome Evaluation Scale.

Background: The purpose was to evaluate the role and impact of the rhinoplasty outcome evaluation (ROE) in rhinoplasty. Objectives: To systematically review the ability of ROE to assess rhinoplasty outcome in the very recent surgical approaches. Data Sources: Searching MESH terms "rhinoplasty" and "rhinoplasty and ROE" on PubMed, Scopus, Embase, Google Scholar, and other major literature databases. Study Eligibility Criteria: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses model was adopted for eligibility criteria. Participants and Interventions: A first large screening on 1,660 papers allowed the final retrieval of 896 reports, of which only 101 were eligible for all the inclusion criteria, which allowed finally to select a group of 12 reports published in the time range 2018-2021. Study Appraisal and Synthesis Methods: Meta-regression with Durbin-Watson test, checking of meta-analysis bias with Rosenthal's estimator, and heterogeneity through the I 2 statistics were performed. The analysis included a Mantel-Haenszel test and associated or meta-analysis. Results: Twelve eligible and qualified papers were included in the meta-analysis, out of 1,263 patients, from 1,660 papers. ROE confirmed previous reports about its ability to discriminate preoperative from postoperative outcome (50/100), as from the different rhinoplasty approaches, a value very close to the functional Nasal Obstruction Symptom Evaluation scale. This study strengthens the role of ROE in the evaluation of rhinoplasty outcomes encouraging further research to improve ROE scale on different cultural habits and geographical areas. Limitations: The main limitations were due to the weak inclusion and exclusion criteria, methodological flaws with the statistical analysis, and poor data synthesis and evaluation in many papers about ROE.

An Italian Online Survey Regarding the Use of Hyaluronidase in Previously Hyaluronic Acid-Injected Noses Looking for Surgical Rhinoplasty.

Background: Nonsurgical nasal reshaping (nSNR) with hyaluronic acid (HA) filler is a well-established procedure performed to ameliorate nasal appearance and is considered a valid alternative to surgical rhinoplasty in selected patients. Objectives: The aim of our study is to evaluate the decision-making process and management of patients undergoing rhinoplasty, with previous HA filler injection, and evaluate if consensus could be achieved to recommend guidelines. Methods: Between April and May 2021, an online survey was sent to 402 Italian surgeons of different specialties. The survey collected information regarding the types of treatment of patients who have previously undergone nSNR, who should undergo surgical rhinoplasty. For those surgeons using hyaluronidase, an additional information was collected. Results: In a range of time of 2 months (April and May 2021), a total of 72 surgeons replied and completed the survey: out of the 402 questionnaires sent, the response rate was approximately 18%. The majority of respondents (61.5%) replied to inject hyaluronidase (HYAL) in patients who had to undergo a rhinoplasty but reported previous nSNR. Of the surgeons who use HYAL, 70% performed rhinoplasty after a waiting time of 3 to 4 weeks. Conclusions: Either direct surgical approach or hyaluronidase injection first seems to be a viable options. The use of HYAL before surgery is the choice with the broadest consensus in our survey. However, a larger case-control study with long follow-ups is necessary to understand if in patient seeking surgical rhinoplasty who already received nSNR, the injection of hyaluronidase before surgery is mandatory, recommended, or not.

Conchal Excision Techniques in Otoplasty: A Literature Review.

Prominent ears are a common congenital deformity of the head and neck. Correcting concha hypertrophy is an important step in otoplasty. Despite the risk of postoperative deformity due to the sharp edges created by excision, removing a section of cartilage is sometimes the only method to obtain a satisfying and long-lasting result. Multiple conchal excision techniques have been reported in the literature, with significant differences in approach, outcome evaluation, and complication classification. The objective was to review cartilage excision-based otoplasty procedures to offer plastic surgeons' insights into current data on outcomes and complications of conchal excision techniques. Methods: We conducted a literature search through the MEDLINE, EMBASE, Scopus, and Cochrane databases. Prospective and retrospective studies on otoplasty, including revision surgeries and conchal excision techniques involving concha cartilage resection, were included. Articles with no outcomes data, review articles, case reports, expert opinion or comment, and nonclinical studies were excluded. Results: There were a total of four manuscripts that fulfilled our criteria. Three out of four authors preferred posterior access that separates the skin excision from the cartilage excision. Following resection, cartilage edges can be approximated by placing cartilage sutures, or they can be allowed to collapse spontaneously. Although only two authors employed a systematic classification for complications, all the articles reviewed indicated a low complication rate and excellent postoperative cosmetic outcomes. Conclusion: Although the techniques and principles stated in the literature varied to some extent, the outcomes of all studies reviewed were comparable.

Surgical and histological evidence of case reports showing Schwannomas in the nasal area.

INTRODUCTION AND IMPORTANCE: Schwannomas are benign neurogenic neoplasms with an uncommon involvement of the nasal cavity and paranasal sinus, which usually appear as a painless formation. We report two cases of nasal schwannoma that was successfully treated by surgical excision with satisfactory functional outcomes. The aim of this study is to discuss the clinical assessment and imaging, (CT, MRI) differential diagnosis, histological examination, surgical approaches of this rarely encountered neoplasm in the sinus-nasal area. CASE PRESENTATION: Case 1: a 53 years-old Caucasian male, hospitalized in the ENT Department with a 5-month progressive history of right nasal obstruction without epistaxis was diagnosed as a Schwannoma following clinical, histology and ENT endoscopy examination. Case 2: a 45 years-old Caucasian male with asymptomatic swelling arising 4 months before in the nasal tip area with progressive nasal deformity, diagnosed as a schwannoma and analyzed with MRI. CLINICAL DISCUSSION: Case 1: The patient had an uneventful post-operative course and a follow-up examination at 36 months showed no recurrence of the neoplasm with satisfactory functional result. Case 2: The patient had an uneventful post-operative course and a follow-up examination at 5 years showed no recurrence of the neoplasm and satisfactory aesthetic result. CONCLUSIONS: Schwannomas arising from sinonasal area are extremely rare, painless and with slow-growing evolution. The surgical option and histologic analysis are mandatory for a correct diagnosis.

The Overfilled Face.

The desire for longevity, beauty, and health is as old as the history of human culture. Minimizing tissue damage and invasive surgeries has led to a variety of options in the 21st century medicine. In the past 20 years, hyaluronic acid filler injections have thus become a popular modality of treatment for facial rejuvenation due to low costs for patients with immediately visible results. Ideally, the treated face looks natural. We aim at stopping time, maybe tweaking the handles of our clocks a bit backward to counteract aging processes, but creating a natural look and maintaining the individual appearance.

Exokine and the Youth-Boosting Treatment Based on One's Own Serum: Wheat and Chaff.

Within the field of skin rejuvenation, clinicians have broadened the application of proven therapies toward antiaging medicine. Specifically, both platelet-rich plasma (PRP) and autologous-conditioned serum (ACS) have received great consideration among experts for novel indications. While the medical research focused on ACS is strengthened in their evidence and supported by promising outcomes, much more debates exist regarding the efficacy of PRP. Despite limited supporting literature to date, physicians and surgeons should be encouraged to explore the use of these approaches and in shedding further light on their potential benefits by contributing new evidence from basic and clinical scientific investigation.

Nonsurgical Rhinoplasty: Long-Term Follow-Up of High G' HA Nasal Injections.

Rhinoplasty is one of the most requested aesthetic procedures performed by plastic surgeons world-wide and nonsurgical rhinoplasty is becoming the gold standard in aesthetic nasal treatment. Follow-up clinical examinations were performed on all 107 patients, being a safe and predictable technique with a high degree of satisfaction for the patients. Nonsurgical rhinoplasty using hyaluronic acid is an effective, fast, and safe nasal reshaping procedure with a high degree of patient satisfaction. Generally, due to the gradual reabsorption of the filler, the results last up to 8 to 12 months after treatment, making it a valid minimally invasive alternative to surgical rhinoplasty. Consequently, to maintain the effects it is necessary to repeat the treatment once a year.

OnabotulinumtoxinA from lines to facial reshaping: A new Italian consensus report.

BACKGROUND: Botulinum neurotoxin type A is the most widely used nonsurgical treatment for esthetic improvement of the face and neck. In 2015, an Italian consensus panel met to discuss the optimal methods for using onabotulinumtoxinA. However, clinical practice continues to evolve and the original report is now considered obsolete. AIMS: To provide updated guidance on the esthetic uses of onabotulinumtoxinA in the face and neck. METHODS: A panel of 10 Italian specialists (including plastic and maxillofacial surgeons, dermatologists, and esthetic doctors) individually completed a questionnaire on their own clinical practice, and then met to discuss their responses and agree on a revised treatment consensus. RESULTS: Recommendations are provided on patient assessment, reconstitution of onabotulinumtoxinA, and preferred procedures (injection sites, doses, anatomical targets, safety precautions, etc.) across a variety of treatment areas, including glabellar, crow's feet, and forehead lines; brow lifting and shaping; lower eyelid hypertrophy; bunny lines; sagging nasal tip; gummy smile; masseter hypertrophy; perioral lines; marionette lines and "sad mouth;" mentalis hypertonia; and platysma bands. Some of the recommended doses are substantially increased from the previous consensus (particularly in the upper third and masseter) for the purpose of achieving longer lasting results without affecting safety. Furthermore, two increasingly popular techniques-the Nefertiti lift and Microbotox-are included in the consensus for the first time. CONCLUSIONS: Optimal practice with onabotulinumtoxinA requires a systematic approach to maximize safety and effectiveness across the range of potential uses. The present consensus was developed to support these aims.

Pinch Anatomy of Forehead: An Injection Guide for Forehead Filler Treatment.

Filler injections have become very popular in recent years, and injectors globally use them for facial shaping and reversing age-related changes. Detailed knowledge about important vessels' and tissue planes' anatomy is essential for injectors. While giving the filler injections, injectors tend to gently pinch or pull the tissue fold with the nondominant hand during the procedure. The deformational forces cause some changes in the anatomy of tissue layers held in a pinch. During the pinch and "pinch and pull" maneuver, the crucial vessels in the area can get pulled up in the tissue layers in a pinch or stay in their position unaffected depending on the force applied. The "pinch and pull" maneuver also increases the tissue space for injections by moving the mobile tissue layers away from the fixed ones. The injector can use knowledge of the "'pinch anatomy" in the forehead to avoid important arteries and place filler in the correct plane. With the understanding of the anatomical changes occurring during the pinched state of tissue layers, filler injection can be performed in the right and safer tissue plane in the forehead. This study reflects level of evidence V.

Botulinum Toxins for Esthetic Facial Injections: A Scientific Review to Support Evidence-Based Best Practice.

Botulinum toxins (BoNT) are complex biological products. Each licensed BoNT type A (BoNTA) has its own individual characteristics resulting into different attributes, some of them being of clinical relevance. Besides profound anatomical knowledge and understanding of esthetic principles, the responsible injecting physician should be aware of those pharmaceutical and clinical properties. Especially against the background of new BoNTA formulations receiving approval by the authorities, a critical and dedicated discussion on the individual characteristics should take place, and the potential relevance on the treatment outcome should be taken into consideration.

Puzzle Facelift: A Nonsurgical, Whole Treatment for Facial Modeling and Rejuvenation.

The assessment of correct anatomy of face and the evaluation of the dynamic interplay between anatomy and function, to get an overall improvement, is a leading topic in aesthetic surgery and has increased its impact in recent years. A nonsurgical impact technique reduces both post-treatment discomfort and the overall cost. Obtaining the simultaneous correction in forehead, nose, lips, and chin means obtaining an overall improvement in face view. Likewise, the high predictability of the procedure and the absence of alloplastic implant, bone re-absorption, and scars have to be considered in nonsurgical aesthetic medicine. In conclusion, a single session of profile correction using hyaluronic acid filler should be proposed to patients, every time the aesthetic practitioner sees a coexistence of forehead, nose lips, and chin defects.

The Role of Er-yag Glass Laser in Skin Resurfacing.

Following our survey, we can appreciate that a variety of laser platforms exist to rejuvenate the skin by resurfacing the outer layer of the skin as well as heating the lower layers of the dermis. Based on reliable clinical effectiveness and a limited side effect profile, we can confirm that nonablative fractionated technologies greatly improve the appearance of lentigines, rhytids; eliminate sun damage, attenuate scarring due to acne and other causes; and treat hyperpigmentation. The Fraxel (Solta Medical) laser system delivers pulses across a wide range of density and energy levels. We determined that when increasing the pulse energy this led to an increase in thermolysis microzone depth and width without damaging the surrounding tissue. Due to its performance and various clinical applications, Fraxel laser can be optimally considered to be the gold standard for skin rejuvenation.