Publications by authors named "Dario Bertossi"

109 Publications

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

Aesthet Surg J Open Forum 2022 4;4:ojac060. Epub 2022 Jul 4.

Multidisciplinary Department of Medical-Surgical and Dental Specialties, Oral and Maxillofacial Surgery Unit, University of Campania "Luigi Vanvitelli", Naples, Italy.

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.
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http://dx.doi.org/10.1093/asjof/ojac060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9317161PMC
July 2022

Conchal Excision Techniques in Otoplasty: A Literature Review.

Plast Reconstr Surg Glob Open 2022 Jun 15;10(6):e4381. Epub 2022 Jun 15.

University Vita-Salute San Raffaele, Milan, Italy.

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.
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http://dx.doi.org/10.1097/GOX.0000000000004381DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9200380PMC
June 2022

The Overfilled Face.

Facial Plast Surg 2022 Apr 12;38(2):173-176. Epub 2022 Jun 12.

Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne Medical Center, Köln, Cologne, Germany.

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 21 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.
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http://dx.doi.org/10.1055/s-0042-1744180DOI Listing
April 2022

Nonsurgical Facial Treatments.

Authors:
Dario Bertossi

Facial Plast Surg 2022 04 12;38(2):95. Epub 2022 Jun 12.

Unit of Maxillo-Facial Surgery, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy.

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http://dx.doi.org/10.1055/s-0042-1749384DOI Listing
April 2022

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

Int J Surg Case Rep 2022 May 4;94:107165. Epub 2022 May 4.

Department of Surgery, Dentistry, Gynaecology, and Paediatrics, Unit of Otorhinolaryngology, University of Verona, Verona, Italy.

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.
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http://dx.doi.org/10.1016/j.ijscr.2022.107165DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9093009PMC
May 2022

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

Facial Plast Surg 2022 Apr 22;38(2):177-181. Epub 2022 Apr 22.

Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy.

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.
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http://dx.doi.org/10.1055/s-0042-1747970DOI Listing
April 2022

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

Facial Plast Surg 2022 Apr 14;38(2):96-101. Epub 2022 Feb 14.

Unit of Otorhinolaryngology, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy.

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.
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http://dx.doi.org/10.1055/s-0042-1742431DOI Listing
April 2022

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

J Cosmet Dermatol 2022 Feb 20;21(2):550-563. Epub 2022 Jan 20.

Private Practice, Rome, Italy.

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.
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http://dx.doi.org/10.1111/jocd.14728DOI Listing
February 2022

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

Facial Plast Surg 2022 04 8;38(2):166-172. Epub 2022 Mar 8.

Fortis Hospital, Mohali, India.

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.
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http://dx.doi.org/10.1055/a-1733-2858DOI Listing
April 2022

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

Facial Plast Surg 2022 04 8;38(2):163-165. Epub 2022 Mar 8.

Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.

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.
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http://dx.doi.org/10.1055/a-1733-2768DOI Listing
April 2022

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

Facial Plast Surg 2022 04 8;38(2):152-155. Epub 2021 Mar 8.

Department of Plastic Surgery, Royal Free Hospitals & University College London, London, United Kingdom.

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.
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http://dx.doi.org/10.1055/a-1730-8270DOI Listing
April 2022

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

Facial Plast Surg 2022 04 10;38(2):156-162. Epub 2022 Mar 10.

Maxillo-Facial Surgery, University of Verona, Verona, Italy.

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.
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http://dx.doi.org/10.1055/a-1730-8436DOI Listing
April 2022

Unexpected Bone Resorption in Mentum Induced by the Soft-Tissue Filler Hyaluronic Acid: A Preliminary Retrospective Cohort Study of Asian Patients.

Plast Reconstr Surg 2022 02;149(2):334e-335e

Department of Surgery, Dentistry, Paediatrics, and Gynaecology, Unit of Maxillofacial Surgery, University of Verona, Verona, Italy.

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http://dx.doi.org/10.1097/PRS.0000000000008798DOI Listing
February 2022

Frontal bone hyperostotic mass associated with fibrous dysplasia in a male patient with systemic lupus erythematosus (SLE).

Int J Surg Case Rep 2021 Dec 18;89:106564. Epub 2021 Nov 18.

Department of Surgery, Dentistry, Paediatrics and Gynaecology, Unit of Otorhinolaryngology, University of Verona, Verona, Italy.

We present a rare clinical report of a 45-year-old man affected by Systemic Lupus Erythematosus (SLE) with a unilateral mass of the left frontal bone, diagnosed as a possible recurrence of fibrous dysplasia. This patient was evaluated with computed tomography (CT scan) and was treated with resection of the mass and reconstruction with splitting a calvarian bone graft. The pathological evidence was suggestive for a bone cavernous haemangioma. No previously described cases of bone dysplasia associated with this systemic syndrome were reported so far. Patient's disease was under stringent control at the time of hospitalization, and the outcome has been successful, even though a mild increase of inflammatory indexes was reported after surgery. This laboratory evidence was transient and not related to further clinical complications.
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http://dx.doi.org/10.1016/j.ijscr.2021.106564DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8645914PMC
December 2021

Lip Reshaping with LOVE Approach: A Prospective Analysis Based on Two Hyaluronic Acid Fillers.

Plast Reconstr Surg Glob Open 2021 Nov 24;9(11):e3957. Epub 2021 Nov 24.

Private Practice, Verona, Italy.

Aesthetic improvement of the lips with hyaluronic acid fillers is a popular procedure. A comprehensive, modular, and highly individualizable method has been developed: the Lip Omnicomprehensive Volume Enhancement (LOVE) approach. The present study assessed the safety and effectiveness of LOVE across different patient age groups.

Methods: This was a prospective, single-center study of women aged 20-70 years seeking nonsurgical lip enhancement or asymmetry correction. Three equally sized groups were formed based on patient age: 20-34, 35-45, and 46 years or older. Individualized treatment plans were developed taking into account patient preferences expressed in a pre-injection questionnaire. Treatment used one or more of the three modules of LOVE: lip shape [vermilion border, Vycross (VYC)-17.5]; volume (vermilion body, VYC-17.5); and hydration (submucosal area, VYC-12). Follow-up lasted 6 months.

Results: Sixty patients were enrolled (mean age: 41.3 ± 13.3 years; n = 20 per age group), all of whom were White. Most were treated with all three LOVE modules. Mean filler quantities increased with age: 20-34 years, 1.1 ± 0.1 mL; 35-45 years, 1.5 ± 0.1 mL; 46 years or older, 1.6 mL ± 0.2 mL. Mean patient satisfaction at 4 weeks [on a seven-point scale from 0 (extremely dissatisfied) to 6 (extremely satisfied)] was 4.8-4.9 in each age group. Apart from minor and transient edema/bruising, there was only one complication: a case of lumps that resolved with home massage.

Conclusion: The LOVE approach is safe and effective across a range of ages, with high levels of patient satisfaction.
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http://dx.doi.org/10.1097/GOX.0000000000003957DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8613371PMC
November 2021

Treating Aging Changes of Facial Anatomical Layers with Hyaluronic Acid Fillers.

Clin Cosmet Investig Dermatol 2021 26;14:1105-1118. Epub 2021 Aug 26.

Department of Maxillo-Facial Surgery, University of Verona, Verona, Italy.

The aging process affects every anatomical layer of the face. Improved knowledge of how aging occurs in each anatomical layer of the face has helped evolve the facial rejuvenation strategies with HA fillers. Understanding the age-related changes in the anatomical facial layers, including their time of onset and how the changes occur in the different tissue layers, an injector can provide much more targeted and refined HA filler treatments. As fillers' use has increased, there has been a distinct shift away from procedures lifting the skin and SMAS. We can selectively target the anatomical facial layers with HA fillers for more refined and predictable outcomes. An extensive range of HA filler variants is now available. Each filler type is optimized and designed to be injected into specific tissue planes for the best results. Knowing the predictable aging changes in the different tissue layers of the face is crucial as this guides the optimum filler choice. Working knowledge of the individual characteristics of the numerous HA-based products allows for their effective placement in the correct layer. Familiarity with the correct HA product may also help to minimize the downtime and risk of adverse events.
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http://dx.doi.org/10.2147/CCID.S294812DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8405095PMC
August 2021

Oral Lichen Planus: risk factors of malignant transformation and follow up. Ten years retrospective study.

J Clin Exp Dent 2021 Jul 1;13(7):e630-e636. Epub 2021 Jul 1.

Associate professor, MD, MS, Department of Surgical Sciences, Paediatrics and Gynaecology, University of Verona. Policlinico G. B. Rossi, Piazzale L. Scuro n.10, 37134, Verona, Italy.

Background: Oral Lichen Planus (OLP) is an inflammatory chronic disease. Modified World Health Organization (WHO) diagnostic criteria (2003) suggest diagnosing OLP both clinically and histologically. Furthermore, it is known the potential of malignant transformation of OLP, especially those affecting mucosa. Aims of this retrospective study on 100 patients were i) to estimate the timing of transformation of OLP lesions in OSCC in a cohort of patients observed between 2008 and 2018; ii) to assess risk factors of OLP patients diagnosed with OSCC; iii) to analyse forms of OLP evolved in cancer.

Material And Methods: A database of 100 patients diagnosed with OLP was evaluated and clinical, histological features of lesions, habits of patients and systemic diseases were analysed in a follow up ranged between 5 and 10 years.

Results: Mean time of malignant transformation was 31,62± 18,26 months; however, 4 malignant transformations out of 8 occurred about after 4 years of observation. Furthermore, Odds ratios for risk factors showed an association between malignant transformation and location.

Conclusions: More focused attention on follow-up scheduling and designing could be a valuable resource in early diagnosis and cancer prevention in OLP patients. Oral Lichen Planus, Oral Cancer, Malignant transformation, risk factors.
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http://dx.doi.org/10.4317/jced.57688DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8291160PMC
July 2021

The 10-Point Plan 2021: Updated Concepts for Improved Procedural Safety During Facial Filler Treatments.

Clin Cosmet Investig Dermatol 2021 6;14:779-814. Epub 2021 Jul 6.

Maxillofacial Department, University of Verona, Verona, Italy.

Dermal filler treatments require constant reassessment for improving and safeguarding the rapidly evolving aesthetic field. Suboptimal injection technique, patient selection and product knowledge have touted a concerning increase in filler complications, with new challenges such as the COVID-19 pandemic leading to new paradigms in the understanding, prevention, diagnosis and treatment of complications. The updated 10-point plan has been developed to curtail complications through consideration of causative factors, categorized as patient, product, and procedure-related. Patient-related factors include a preprocedural consultation with careful elucidation of skin conditions (acne, rosacea, dermatitis), systemic disease (allergies, autoimmune disease, underlying bacterial and viral disease (herpes simplex virus, COVID-19 infection), medications (antineoplastic drugs, recreational drugs) and previous cosmetic procedures (including fillers and energy-based devices). Patient assessment should include standardized photography and also evaluate the role of social media, ethnicity, gender, generational, and LGBTQ+ needs. Specified informed consent for both adverse events and their treatment is essential due to the increase in vascular complications, including the risk of blindness. Product-related factors include the powerful advantage of reversibility when using hyaluronic acid (HA) products. Product characteristics such as molecular weight and filler degradation should be understood. Product layering over late or minimally degradable fillers is still inadvisable due to the initial filler being teased into reactivity. Procedural factors such as consistent photographic documentation, procedural planning, aseptic non-touch technique (ANTT), knowledge of topographical anatomy and angiosomes, and technical dexterity including pinch anatomy and needle skills are of pivotal importance. The final section is dedicated to algorithms and checklists for managing and treating complications such as allergic hypersensitivity reactions, vascular events, infection, edema and late-onset adverse events (LOAEs). The updated 10-point plan is a methodical strategy aimed at further minimising the risk of dermal filler complications.
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http://dx.doi.org/10.2147/CCID.S315711DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8279269PMC
July 2021

Insights on the mechanisms of action of ozone in the medical therapy against COVID-19.

Int Immunopharmacol 2021 Jul 11;96:107777. Epub 2021 May 11.

SIOOT, High School in Oxygen Ozone Therapy, University of Pavia, Italy; SIOOT INTERNATIONAL, Communian Clinic, Gorle Bergamo, Italy; Villa Mafalda Clinics via Monte delle Gioie, Rome, Italy.

An increasing amount of reports in the literature is showing that medical ozone (O) is used, with encouraging results, in treating COVID-19 patients, optimizing pain and symptoms relief, respiratory parameters, inflammatory and coagulation markers and the overall health status, so reducing significantly how much time patients underwent hospitalization and intensive care. To date, aside from mechanisms taking into account the ability of O to activate a rapid oxidative stress response, by up-regulating antioxidant and scavenging enzymes, no sound hypothesis was addressed to attempt a synopsis of how O should act on COVID-19. The knowledge on how O works on inflammation and thrombosis mechanisms is of the utmost importance to make physicians endowed with new guns against SARS-CoV2 pandemic. This review tries to address this issue, so to expand the debate in the scientific community.
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http://dx.doi.org/10.1016/j.intimp.2021.107777DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8112288PMC
July 2021

Minimally invasive aesthetic treatment of male patients: The importance of consultation and the lower third of the face.

J Cosmet Dermatol 2021 Jul 24;20(7):2086-2092. Epub 2021 May 24.

Department of Surgery, Dentistry, Pediatrics and Gynaecology, University of Verona, Policlinico G.B. Rossi, Piazzale LA Scuro 10, Verona, Italy, 37134, Italy.

Background: Men worry disproportionately about potential negative consequences of facial aesthetic treatment with injectable therapies, such as side effects or appearing more feminine. Features of the lower third of the face (eg, prominent chin and jaw) are particularly important in perceptions of masculinity. A strategy has been developed for male patients based on an initial consultation emphasizing the safety and masculinizing potential of injectables, followed by treatment with a high G' hyaluronic acid filler targeting the lower third.

Aims: To assess this strategy in routine practice.

Methods: This was a retrospective analysis of male patients with poor definition of the lower third of the face wishing to undergo non-surgical correction. Initial consultation focused on detailed patient education and facial masculinization with injectables. Individuals were then treated in the lower third using VYC-25 based on the standardized MD Codes approach. Follow-up lasted ≤12 months.

Results: Forty patients were included (mean age: 40.9 ± 9.6 years). The mean volume of VYC-25 injected into the lower third was 7.8 ± 1.2 ml. Patient satisfaction was high, as assessed using the FACE-Q "Satisfaction with outcome" questionnaire (mean Rasch-transformed score: 88.1 ± 10.3). Complications included the following: soft tissue edema, n = 12 (30.0%); hematoma, n = 6 (15.0%); and telangiectasia, n = 2 (5.0%). All were early, transient, and minor; there were no major or delayed events.

Conclusions: This approach to male subjects was practical and safe despite the large volumes of filler used. Focusing on the lower third may help to reassure patients and deliver results that respect masculine identity.
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http://dx.doi.org/10.1111/jocd.14231DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8361772PMC
July 2021

Selective denervation of the corrugator supercilii muscle for the treatment of idiopatic trigeminal neuralgia purely paroxysmal distributed in the supraorbital and suprathrochlear dermatomes.

J Headache Pain 2021 Mar 4;22(1). Epub 2021 Mar 4.

Global Medical Institute and Swiss Nerve Center, Lausanne, Switzerland.

Introduction: Idiopatic trigeminal neuralgia purely paroxysmal (ITNp) distributed in the supraorbital and suprathrochlear dermatomes (SSd), refractory to conventional treatments have been linked to the hyperactivity of the corrugator supercilii muscle (CSM). In these patients, the inactivation of the CSM via botulinum toxin type A (BTA) injections has been proven to be safe and effective in reducing migraine burden. The main limitation of BTA is the need of repetitive injections and relative high costs. Based on the study of the motor innervation of the CSM, we describe here an alternative approach to improve these type of migraines, based on a minimally invasive denervation of the CSM.

Materials And Methods: Motor innervation and feasibility of selective CSM denervation was first studied on fresh frozen cadavers. Once the technique was safely established, 15 patients were enrolled. To be considered eligible, patients had to meet the following criteria: positive response to BTA treatment, migraine disability assessment score > 24, > 15 migraine days/month, no occipital/temporal trigger points and plausible reasons to discontinue BTA treatment. Pre- and post- operative migraine headache index (MHI) were compared, and complications were classified following the Clavien-Dindo classification (CDC).

Results: Fifteen patients (9 females and 6 males) underwent the described surgical procedure. The mean age was 41 ± 10 years. Migraine headache episodes decreased from 24 ± 4 day/month to 2 ± 2 (p < 0.001) The MHI decreased from 208 ± 35 to 10 ± 11 (p < 0.001). One patient (7%) had a grade I complication according to the CDC. No patient needed a second operative procedure.

Conclusions: Our findings suggest that the selective CSM denervation represents a safe and minimally invasive approach to improve ITNp distributed in the SSd associated with CSM hyperactivation.

Trial Registration: The data collection was conducted as a retrospective quality assessment study and all procedures were performed in accordance with the ethical standards of the national research committee and the 1964 Helsinki Declaration and its later amendments.
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http://dx.doi.org/10.1186/s10194-021-01218-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7931360PMC
March 2021

An unusual case of gardening ocular injury during Covid-19 lockdown.

Int J Surg Case Rep 2021 Mar 5;80:105619. Epub 2021 Feb 5.

G.B. Rossi Hospital and Medical University of Verona, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.

Introduction: Facial trauma are an important cause of serious ocular morbidity. In particular domestic trauma are a small part of total. COVID-19 pandemic has been influencing our life in a way never seen before, people need to remain at home due to lockdown restrictions. In this scenario we are seeing an increase in the percentage of domestic facial trauma. In other hand pandemic has influenced the possibility of hospitalization, so daily based procedures increased their importance in global treatment planning.

Case Presentation: A 58 yo man presented to our ward with a foreign body in left eyebrow. Trauma happened during gardening.

Clinical Discussion: The importance of imaging to perform the right procedure has become more important during pandemic to reduce time of hospitalization.

Conclusion: CT scan and ophtalmology consult have been the guideline to avoid a more invasive treatment which was performed in an outpatient regimen with local anesthesia.
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http://dx.doi.org/10.1016/j.ijscr.2021.02.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7893445PMC
March 2021

Laser-Assisted Rhinoplasty: The Future Generation Rhinoplasty Technique to Preserve Anatomy? A Series of Patients Compared to Patients Undergoing Standard Open Rhinoplasty.

Plast Reconstr Surg 2021 02;147(2):364-369

From the Maxillofacial Plastic Surgery Unit, Policlinico G.B. Rossi University of Verona; private practice; and the Department of Neurosciences, Biomedicine, and Movement Sciences, Anatomy and Histology Section; and Dental Clinic and Maxillofacial Department, University of Verona.

Background: Rhinoplasty is the cosmetic procedure that is most difficult to master. Anatomical preservation should represent the main goal of rhinoplasty. One emerging tool appears to be erbium:yttrium-aluminum-garnet laser bone and cartilage reshaping. The authors developed a new small laser hand probe to perform what we called laser-assisted rhinoplasty. The authors evaluate the feasibility of the laser-assisted rhinoplasty and the aesthetic and functional result of laser-assisted rhinoplasty compared to classic rhinoplasty.

Methods: A total of 50 patients were enrolled and randomized into two cohorts: the first cohort of patients was submitted to classic rhinoplasty, and the second cohort to laser-assisted rhinoplasty. The laser beam was used to perform both the resection of the crura and the resection of the nasal hump and osteotomies.

Results: Laser-assisted rhinoplasty is a safe and reproducible technique. At a clinical assessment, lateral crura reshaping showed a visible step or excessive skin retraction in 12 percent of the classic rhinoplasty population with thick cartilage and/or thin skin, and this was not present in the laser-assisted rhinoplasty population at 12-month follow-up. The patient satisfaction rate was higher in the laser-assisted rhinoplasty population compared with standard open rhinoplasty. The authors also clinically noted a reduction in edema in the immediate postoperative period in the laser-assisted rhinoplasty population and a more rapid complete resolution of the swelling.

Conclusion: The laser-assisted rhinoplasty technique is feasible and safe and has no major complication, and the aesthetic and functional results can be superimposed onto classic rhinoplasty but with a higher degree of intraoperative precision, higher patient satisfaction, a cleaner field, and less bleeding.
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http://dx.doi.org/10.1097/PRS.0000000000007590DOI Listing
February 2021

The need for a correct oxygen-ozone autohemotherapy (O-AHT) in patients with mild to moderate COVID-19 pneumonia.

Intern Emerg Med 2021 04 5;16(3):793-794. Epub 2021 Jan 5.

Italian Society for Oxygen-Ozone Therapy (SIOOT), High School in Oxygen Ozone Therapy, University of Pavia, Pavia, Italy.

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http://dx.doi.org/10.1007/s11739-020-02592-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7782567PMC
April 2021

Invisalign appliance: aesthetic and efficiency.

Minerva Stomatol 2020 Dec;69(6):329-334

Department of Dentistry, Dental School, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.

Background: The patients' request for treatment with clear aligners is constantly increasing. The aligners permit to the clinicians a valid way to solve a lot of orthodontic cases but the patients' compliance and the clinicians' capabilities and knowledge of the technique is fundamental for the outcome.

Methods: Seventy-two digital models of 18 consecutive patients treated with Invisalign and Smart Track aligners for 14 weeks were analyzed. The operator positioned 24 points on each model and were obtained the values of arch depth and perimeter of arch before and after the treatment. The variations of measurement were calculated with t student test.

Results: A decrease of arch depth and perimeter was found from t0 to t1 and the most relevant difference was observed in the upper arch depth with a decrease of 1.3 mm and in the upper arch perimeter with a difference of 1.1 mm.

Conclusions: There was always a decrease of the values of arch depth and arch perimeter at the end of the treatment, especially in the upper arch. These changes must be considered by the clinicians to perform a better treatment to obtain the most predictable results and a patient's higher satisfaction.
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http://dx.doi.org/10.23736/S0026-4970.20.04128-XDOI Listing
December 2020

Aesthetic Dentistry, How You Say and How You See: A 500-People Survey on Digital Preview and Color Perception.

Clin Cosmet Investig Dent 2020 21;12:377-389. Epub 2020 Sep 21.

Department of Surgical Sciences, Paediatrics and Gynecology, University of Verona, Verona, Italy.

Purpose: Digital technologies have improved ways to perform aesthetic dentistry in the last few years. The aims of this survey were to investigate the most preferred way to preview the result of an aesthetic dental rehabilitation among a population of dental professionals and laypeople and to compare aesthetic standards of the general population and dentists in terms of the color of teeth for aesthetic dental rehabilitations.

Patients And Methods: A questionnaire was sent to the subjects (dentists and laypeople) during a 1-year period and, together with their demographic data, different ways to preview the result of an aesthetic rehabilitation were submitted, such as digital smile design, dental wax-up and oral explanation. Furthermore, an additional section of the questionnaire investigated the most suitable color for an aesthetic rehabilitation based on the colors of the VITA Scale. Results were statistically analyzed (with Chi-square of independence and Mann-Whitney -test) highlighting differences of answers based on age groups, educational attainment, gender, and belonging or not to the dental field.

Results: Findings showed that digital smile design (digital preview) is a high-appreciated method for previewing and communicating with patients both by dental professionals and laypeople. Furthermore, lighter colors were found to be more valued by laypeople and significant differences were highlighted between the two populations assessed.

Conclusion: It seems to be viable to use digital preview for dentists and laypeople to improve previewing and communicating ways. It might be advisable to better motivate patients in recognizing aesthetical features and to raise their awareness in preferring more mimetic aesthetic results. Great opportunities are opened up by digital smile design in teaching, learning, and routine practice.
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http://dx.doi.org/10.2147/CCIDE.S274669DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7518775PMC
September 2020

How to deal with coronavirus disease 2019: A comprehensive narrative review about oral involvement of the disease.

Clin Exp Dent Res 2021 02 5;7(1):101-108. Epub 2020 Oct 5.

Section of Dentistry and Maxillofacial Surgery, Department of Surgical Sciences, Paediatrics and Gynaecology, University of Verona, Verona, Italy.

Objectives: The aim of this narrative review was to collect all findings from literature about oral signs and symptoms of COVID-19, in order to draw a picture of oral involvement of this challenging viral infection, to help oral professionals in a better triage and early diagnosis.

Material And Methods: The search for international literature was made including articles written in English and reporting about oral manifestations in patients with a diagnosis of COVID-19. The publication time was limited to 2019 and 2020, up to May 20, 2020. A narrative review was performed.

Results: Twenty-three articles were included in this review. Three different oral manifestations were found: taste alteration, oral blister and ulcers, and oral lesions associated with Kawasaki-like diseases (erythema, bleeding of lips, "strawberry tongue"). The higher expression of Angiotensin-converting enzyme 2 in the oral cavity and in endothelial cells might be responsible for oral manifestation and the major report of signs and symptoms in the occidental countries.

Conclusions: Detecting oral signs and symptoms of COVID-19 could be useful to perform a better preliminary triage in dental setting, and in recognizing possible early manifestations of the disease. However, considering the outbreak of COVID-19 and the consequent difficulty of undergoing oral examinations, the oral manifestations might be misdiagnosed; then, we would encourage oral professionals to perform other studies about this topic.
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http://dx.doi.org/10.1002/cre2.332DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7675550PMC
February 2021

Oxygen-ozone (O-O) immunoceutical therapy for patients with COVID-19. Preliminary evidence reported.

Int Immunopharmacol 2020 Nov 8;88:106879. Epub 2020 Aug 8.

SIOOT INTERNATIONAL, Communian Clinic, Gorle Bergamo, Italy; Department of Drug Science, University of Pavia, Italy.

Objective: This study evaluated the potential efficacy of a novel approach to treat COVID-19 patients, using an oxygen-ozone (O-O) mixture, via a process called Oxygen-Ozone- Immunoceutical Therapy. The methodology met the criteria of a novel, promising approach to treat successfully elderly COVID-19 patients, particularly when hospitalized in intensive care units (ICUs) Experimental design: We investigated the therapeutic effect of 4 cycles of O-O in 50 hospitalized COVID-19 subjects suffering from acute respiratory disease syndrome (ARDS), aged more than 60 years, all males and undergoing non invasive mechanical ventilation in ICUs.

Results: Following O-O treatment a significant improvement in inflammation and oxygenation indexes occurred rapidly and within the first 9 days after the treatment, despite the expected 14-20 days. A significant reduction of inflammatory and thromboembolic markers (CRP, IL-6, D-dimer) was observed. Furthermore, amelioration in the major respiratory indexes, such as respiratory and gas exchange markers (SatO%, PaO/FiO ratio), was reported.

Conclusion: Our results show that O-O treatment would be a promising therapy for COVID-19 patients. It leads patients to a fast recovery from ARDS via the improvement of major respiratory indexes and blood gas parameters, following a relatively short time of dispensed forced ventilation (about one to two weeks). This study may encourage the scientific community to further investigate and evaluate the proposed method for the treatment of COVID-19 patients.
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http://dx.doi.org/10.1016/j.intimp.2020.106879DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7414302PMC
November 2020
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