Motta & Partners – Medicina e Chirurgia Estetica e Ricostruttiva

SERVICES

FACIAL COSMETIC SURGERY

Blepharoplasty

Excess skin on the upper eyelids or so-called “bags” under the eyes can make eyes look dull and aged. This generally occurs in adulthood and progressively tends to worsen over the years, but in some cases they are already present at a young age, especially when there is a family history. The problem can be solved through blepharoplasty surgery. Through specific incisions, the surgeon partially and selectively removes the surplus skin and the fat responsible for the bags, ensuring that the scars are slight or not visible at all. The operation is performed under local anaesthesia or with a mild sedation in a day-hospital setting and lasts around half an hour for the upper eyelids and the same for the lower ones. The post-operative recovery is virtually painless and after a couple of hours the patient can return home with small patches that hide the wounds and limit the swelling. Upon request by the patient it is possible to carry out modifications such as making a particularly dull or sad look more lively by using minimal technical variations.

Rhinoplasty

It is a surgical operation that can have only aesthetic purposes or combine functional aspects. It involves the partial or complete remodelling of the bone and cartilage structures of the nose. Rhinoplasty can correct imperfections of the nose which are sometimes a source of discomfort for many people. Through small incisions made inside the nostrils which are externally invisible, the surgeon can correct many defects: a bump or a low bridge, nostrils that are too wide, a tip that is too large, a nose that turns down or up too much. Rhinoplasty is a completely painless surgical procedure and the minor discomforts resulting from the intervention are related to going out in public in the days following the intervention. In fact, the patient wears a splint on the nasal bridge for about a week and often presents swelling and bruises in the eyelid region. This operation is usually performed under general anaesthesia or under sedation as a day case or with a very short hospitalisation. Small tip corrections can be performed under local anaesthesia with immediate discharge. In addition to aesthetic indications, when necessary, functional indications are associated due to which a deviation of the nasal septum or a hypertrophy of the turbinates can be treated during an aesthetic rhinoplasty or, conversely, the functional need may be an opportunity to correct aesthetic defects which, in themselves, would not have been sufficient to lead the patient to have surgery. Aesthetic rhinoplasty is, par excellence, a transformative intervention. The patient asks for a change of a physical feature and based on this consideration, it is fundamental that the shape and the volume of the nose are the result of a considered evaluation of the face as a whole in order to produce a completely harmonious result.

Temporal lift

An attractive look is often characterised by a harmonious eyebrow shape. This anatomical area strongly conditions the expressiveness of the face to the point of being a key element of facial mimicry. The position and shape of the eyebrow arch is a genetically programmed individual prerogative that tends to change with age when there is a progressive ptosis of the cutaneous muscle tissues which leads to a reduction in the anatomical space of the upper eyelid. Daily makeup combined with the widespread habit of pulling out the eyebrows or even permanent hair removal replaced by dermopigmentation are among the most common decorative attempts to produce a more captivating and interesting look through the modification of the design of the eyebrow arch. Temporal lift is a surgical procedure that is carried out to remedy an eyebrow ptosis or to modify an unpleasant eyebrow position. It is a minimally invasive surgery that quickly returns the patient to sociality, leaving limited and well hidden after-effects in the first few days after the procedure. It is usually performed in a day-hospital setting with a mild intravenous sedation supported by local anaesthetic in order to prevent not only the pain but also the emotional element. Through a small incision in the scalp, the surgeon performs a detachment of the skin and the muscles of the forehead in a traditional way or with the aid of the endoscope, in order to reposition them according to a preoperative plan, redefining the design of the eyebrow arch.

Face and neck lift

The face and neck lift or cervicofacial rhytidoplasty rejuvenates the appearance of the face and neck by repositioning the muscle and skin tissues of the lower third of the face and neck which relaxed due to ageing or excessive weight loss. The procedure involves an incision, the size of which depends on the extent of the programmed operation, located immediately near the front portion of the auricle and in the retroauricular sulcus. The facelift is performed under sedation or under general anaesthesia in a day-hospital setting. The facelift is a surgical procedure that has the purpose of “lifting” areas of the face or neck. Depending on the areas involved, the facelift is described as frontal, temporal, midface, facial or cervical and each region can be treated individually or together with other ones. The ideal candidate for a facelift is a patient who has a visible reduction of the skin tone associated with relaxed and sagging skin and, precisely because of these considerations, this is the type of surgery that more than any other aims for the goal of rejuvenation. We make incisions possibly in areas which are hidden and obviously dependent on the area concerned; around the ears and sometimes below the chin for the face and neck area, in the lower palpebral margin for the midface area, and in the scalp for the frontal and temporal region. These incisions produce a cutaneous or muscular disconnection of the face by relocating the muscular structures to the position they had before the skin ageing process. The work is then completed by removing the excess skin. This procedure can be more or less moderate depending on the needs of the patient, provided that the balance between rejuvenation and naturalness of the result must be the guide for our work. More and more frequently the media introduce alleged innovations in this field: we read about mini facelift, soft lift, “lunch hour” facelift, endoscopic facelift, thread facelift, vertical facelift; this heterogeneous terminology describes a procedure that in its mode of execution can involve different technical resolutions with different levels of surgical engagement and result. Which strategy to choose is rather simple: the outcome of a facelift is almost always proportional to the level of invasiveness of the technique, but this does not mean that minor techniques should not be taken into account. Moderate techniques produce a more natural result, they last for a shorter time but they enable patients to go out in public quicker; the more invasive the technique, the more stable the result will be over time, involving a longer post-operative recovery. Complications are rather rare and are typical of all surgery: bad scarring, haematomas, possible infections or nerve lesions. The duration of the procedure, the hospitalisation and the type of anaesthesia are dependent on the extent of the technique used and the areas involved. They procedures can range from half an hour under local anaesthesia in an outpatient procedure for the application of subcutaneous wires to four hours under general anaesthesia with twenty-four hours hospitalisation for a complete facelift.

Midface lift

The midface lift, also known as SOOF facelift or cheek lift involves a lift of the malar area through an incision located at the edge of the eyelashes of the lower eyelid. The surgeon accesses and mobilises the soft tissues of the anterior area of the cheekbone to lift them up and anchor them in a higher position to produce a more toned form. The operation is performed under local anaesthesia with sedation and a few hours’ hospitalisation. It involves social unease for about ten days due to the swelling.

Augmentation mentoplasty

Augmentation mentoplasty allows volume increase and remodelling of the chin shape with a prosthetic implant. The procedure involves a small incision that can be located in the submental groove or in the oral cavity through which space is created near the bone where the prosthesis will be placed. A preoperative computerised simulation is performed during the visit to evaluate the extent of the increase and the most suitable prosthesis. Alternatively, it is possible to reconstruct the patient’s skeletal structure using computed tomography data and a 3D printer to reconstruct a model with a bone from a bone bank. Last but not least, we should mention the less demanding alternative of the use of soft tissue fillers for smaller volumes. The operation is carried out under local anaesthesia with sedation in a day-hospital setting.

Reduction mentoplasty

Reduction mentoplasty allows the reduction of the chin through the bone remodelling that is carried out with a bone cutter through an access drilled in the oral cavity. A pre-operative computerised simulation is usually performed to programme the extent of the work. Reduction mentoplasty is performed in sedation in a day-hospital setting.

Augmentation malarplasty

Augmentation malarplasty allows to increase cheekbones in volume and to remodel them through the prosthetic implant. The procedure is performed under local anaesthesia supported by sedation with a few hours’ hospitalisation. The incision is made along the ciliary margin of the lower eyelid or in the oral cavity. This procedure is frequently replaced by filling with autologous adipose tissue (lipofilling) or with fillers.

Otoplasty

Otoplasty allows correction of auricle deformities such as the excessive protrusion from the skull or the disharmony of the shape. The procedure involves a scar in the retroauricular sulcus and local anaesthesia with a possible sedation and a few hours’ hospitalisation. It is also possible to carry out the operation in pediatric age. When we speak of sticking-out or big ears, we refer to a small anomaly of the shape of the auricle which is easily corrected through a very simple surgical procedure called otoplasty. Sticking-out ears appear in childhood and the cause is not due, as many think, to trauma or to a bad sleeping position but is genetically programmed. The shape defect may involve only one or more components of the cartilaginous auricle which is the structure that produces the shape of the ear. Otoplasty is performed in an outpatient or day-hospital setting under local anaesthesia or with mild sedation and the patient can return home a few hours after treatment. Through an incision hidden in the groove behind the ear, the surgeon corrects the cartilage by removing the surplus portion when necessary and remodelling some areas in order to reproduce a completely natural form. The intervention can also be performed in pre-school children to avoid psychological discomfort and it lasts for around forty minutes.

Lip lift

It is possible to perform a modest rotation and an increase of the lip through the eversion of the mucosa carried out with micro internal incisions or by making a small cut close to the lower portion of the nostrils or the upper edge of the lips themselves. Overall, these procedures are performed under local anaesthesia in an outpatient setting.

Augmentation labiaplasty

With augmentation labiaplasty, the volume of the lips is increased by implanting a prosthesis. Under local anaesthesia, two small incisions are made inside the lips through which the chosen soft-silicone prosthesis is inserted in a deep plane. The post-treatment discomfort is represented by swelling which lasts for around a week. Alternatively, it is possible to resort to lipofilling, that is, to an autologous adipose tissue graft.

BODY BEAUTIFICATION SURGERY

Liposuction

Liposuction, also referred to as lipoaspiration or liposculpture, allows the reduction of localised adiposities and the irreversible remodelling of the body silhouette. Unlike a diet, it is not aimed at reducing body weight, but reshaping the form by eliminating localised fat surpluses. In addition to the classic technique, there are variants with specific indications such as vibro-liposuction, laser lipolysis or ultrasound lipolysis. With these procedures, it is possible to remove the fat in many anatomic areas such as the abdomen and the hips or the back, the thighs, the knees and the ankles or the arms. Depending on the scope or volume, the procedure is made on a day-case or hospitalisation basis under local anaesthesia with sedation or general anaesthesia.

Abdominoplasty

Abdominoplasty is a surgical procedure that involves the removal of abdominal excess skin and adipose tissue and the correction of any muscle flaccidity. The ideal candidates for this intervention are therefore patients with a particularly pronounced and sagging abdomen, those who have lost weight, women who have undergone one or more pregnancies or simply those who have suffered a significant loss of muscle and abdominal tissue tone. Through a linear cut performed above the pubis, the surgeon will remove excess skin and adipose tissue and, when necessary, will correct the eventual diastasis of the rectus muscles by completely rebuilding the abdominal wall. Following the intervention, the patient will be left with a scar from the pubic area towards the hips, more or less pronounced according to the extent of the surgical act itself, but still well hidden under underwear or swimsuit. The procedure can be partial, also called mini abdominoplasty, when it only affects the portion below the navel or complete, with the transposition of the navel, when extending up to the costal margin. Sometimes it is also associated with a liposuction of localised adiposity or the correction of the diastasis of the rectus muscles or of any hernias of the abdominal wall. In most cases, the procedure takes place under general anaesthesia with a brief hospitalisation.

Gynaecomastia correction

Normally, the mammary gland is absent in childhood and begins to develop, albeit in small quantities, even in males during puberty. The term gynaecomastia indicates an excessive development of the mammary gland in humans. In most cases, especially in overweight patients, there is actually an abnormal increase in adipose tissue in this region and in these circumstances it is preferable to speak of pseudogynecomastia. Gynaecomastia is rarely a pathology worthy of note, if not for the psychological discomfort caused to the patient by the unsightliness associated with it, as he often will avoid any situation with a bare chest showing or avoid wearing tight clothing. Once the hormonal dysfunction is solved, the solution to the problem is surgical. We rely on liposuction in cases of pseudogynecomastia. The excess fat tissue is removed through very small incisions and special cannulas, producing a volumetric reduction and a consequent re-adaptation of the skin to the new shape. In the most voluminous cases, it is advisable not to completely empty the area in order to avoid a breakdown of the skin or to programme a skin removal around the areola knowing that the scar residue could be visible and, again, a source of discomfort. In the cases of true gynaecomastia, it is possible to perform a liposuction by removing part of the mammary gland with the help of the cannulas or resorting to the traditional intervention in which the breast tissue is surgically removed through an incision on the edge of the areola. In either case, it is advisable to evaluate how much the skin can readjust after treatment and consider the possibility of a removal of periareolar skin even if with more evident scar residue. The operation is performed under local anaesthesia with sedation in a day-hospital setting without any particular inconvenience for the patient during surgery and during the post-operative period.

Cosmetic surgery of the male pectorals

In addition to the correction of gynaecomastia, there are volumetric augmentation procedures and remodelling of the shape of the male pectoral muscles through the submuscular implant of prostheses with periareolar or axillary access. The operation is performed under general anaesthesia with hospitalisation in the day hospital.

Brachioplasty

The problems that cause a patient to turn to the plastic surgeon to improve the aesthetics of their arms are essentially linked to the excess skin that is revealed above all with open arms or in the presence of adiposity. The ageing of the skin involves a reduction in the skin tone that can become very unsightly on the upper limbs. A similar condition occurs in subjects undergoing significant diets in which the skin does not adjust properly to a reduction of the adipose component of the limbs. In subjects with localised fat and good skin turgor, liposuction can be performed under local anaesthesia using a micro incision in the elbow or in the axillary cavity with a reasonable reduction in volume. Patients with mild skin laxity may opt for a mini lift of the arms with minimal incision in the axillary cavity. In major cases a lift or brachioplasty is indicated with an incision on the internal surface of the arms from the axillary to the elbow through which the excess skin is completely removed. These procedures are performed in a day-hospital setting under general anaesthesia or under local anaesthesia with the support of sedation. In any case, these are not very painful procedures that allow patients to return to work and social life almost immediately.

Hand cosmetic surgery

Over the years, the skin of the hands loses elasticity, becomes wrinkled and develops blemishes faster than other areas of the body due to the increased environmental exposure to which this area is subject. To improve the quality of a suffering skin or slow down its ageing, it is possible to resort to micro-injections of bio-revitalising substances in order to hydrate and nourish it. Peeling and laser are equally effective solutions for slightly more damaged hands. In cases of severe ageing it is possible to tackle the problem surgically. A withered hand can be treated with lipofilling or with autologous adipose tissue implants that will thicken the subcutaneous skin with a pleasant turgidity and an adequate cutaneous distension. In patients with severe dermatochalasis and high aesthetic demands, it is also possible to plan a hand lift through which excess skin can be completely removed.

Augmentation gluteoplasty

The main and most classic procedure to increase the volume and projection of the buttock is augmentation gluteoplasty. The surgeon houses a prosthesis in the gluteus maximus muscle, creating an improvement in the shape and an indirect lifting effect proportional to the implant volume. This is a demanding procedure that involves a few days of abstention from physical activity. Alternatively, a more modest filling can be performed using autologous adipose tissue or high-density hyaluronic acid. The gluteal lipofilling requires a preliminary liposuction to obtain a certain volume of adipose tissue which is then injected into the gluteal area. The hyaluronic-acid-based filler is an optimal solution when a contained volume is required with an immediate result. It is performed as an outpatient procedure and patients can return to social and work life immediately. In a standing position, a plan is made to define the areas in the upper quadrants which will house the implant and then the treatment is performed with the patient in a prone position. The product is injected with appropriate cannulas through a microscopic incision under local anaesthesia. The limit of augmentation gluteoplasty through macro filler is the reversibility of the result, in fact, the hyaluronic acid is resorbed over time and to obtain a stable result, a small maintenance retouch should be scheduled every year.

Buttock lift

The gluteal lift corrects ptosis by producing a b-side lift through removal of excess skin and soft tissue suspension. There are different possible incisions that are made in the upper portion of the buttock where scars may stay and it is also possible at the same time to perform lipofilling when a volume increase is also required. The operation is performed under general or spinal anaesthesia with one day hospitalisation.

Thigh lift

Dermolipectomy of the thighs allows flaccidity and excess skin of the thighs to be corrected. A scar in the inguinal groove with an extension proportional to the severity of the case remains from the procedure. Depending on the surgical time, the procedure can be performed under local anaesthesia and sedation or general anaesthesia.

Cosmetic surgery of the calves

This allows volume increase and enhancement of the shape of the calves through a prosthetic implant with a scar in the popliteal fossa. The procedure is performed under local anaesthesia with sedation or general anaesthesia or under spinal anaesthesia in a day-hospital setting. Sometimes lipofilling or hyaluronic acid is used for minor fills.

AESTHETIC SURGERY OF THE BREAST

Augmentation mastoplasty

A naturally undeveloped breast, a reduction in volume after weight loss or after a pregnancy or a loss of tone of the breast tissue due to the ageing processes can be corrected through a surgical procedure called breast augmentation. It is one of the most sought after cosmetic surgery operations among women and among the most widespread in the world. Augmentation mammoplasty can be performed through multiple techniques, each of which has advantages and limits for which the best possible strategy must be evaluated on a case-by-case basis. First of all, we need to choose the access or where to locate the incision that will allow the introduction of the prosthesis. Access from the axilla has the advantage of not leaving necessary scars for the mammary region but sometimes leaves visible after-effects in the axillary cavity. Access from the inframammary fold can sometimes lead to a rather unsightly scar in some positions but it is most suitable for large-volume prosthetics. Access from the areola is the most practiced because it leaves a scar that is not very evident but it can involve temporary alterations to the sensitivity of the skin in this area. As far as placement is concerned, it is possible to place the implant in a superficial position with respect to the muscular plane or in a deeper space. Supramuscular (or subglandular) implants are surgically simpler and less painful in the postoperative period but, as it is understandable, they are not suitable for thin patients because the prostheses can become very evident. The submuscular or partially submuscular implants involve a greater commitment on the part of the patient but often turn out to be the most suitable especially for the patients of a slim build. There is also a certain variability in breast implants. Almost all implants are made entirely of silicone, but there are some covered with polyurethane or with physiological saline solution content. From the point of view of the form, there are round prostheses and anatomic prostheses. In planning a procedure, all possible opportunities are evaluated so that each procedure is customized. Patients with breast implants can undergo diagnostic tests such as ultrasound, mammography and magnetic resonance. The functionality of the mammary glands is not affected by the procedure and the prostheses do not need to be replaced after a few years. Surgery is performed preferably under general anaesthesia in a day-hospital setting.

Mastopexy

Mastopexy or breast uplift allows sagging breasts to be lifted and reshaped. This request is very frequent in adult women who have previously breastfed or in cases of weight loss or simply due to tissue failure. An essential aspect of this surgery is the preoperative planning in which the surgeon and the patient evaluate the possible results according to the initial condition and expectations. The initial anatomy, the clinical history and the type of skin will be examined in relation to the desired shape and volume. The most deterrent part in addressing mastopexy surgery is the extension of scars. In the milder forms of ptosis in which there is a need for a limited uplift, it is possible to resort to periareolar mastopexy, that is, raising the nipple-areolar complex by only removing the skin around the areola to produce a scar that is confined to that area. When the desire for a greater uplift takes place, more skin has to be removed with the consequent extension of the scar around the areola as well as vertically between the lower edge of the areola down to the inframammary fold. In the most serious cases, the incision is made even in the inframammary fold and produces a sort of anchor or inverted T. During the operation, besides the removal of skin, a complete reshaping of the mammary gland is carried out, which, depending on the case, is repositioned higher with a new volume distribution in a more compact and pleasant shape. When the patient wishes to improve the shape and increase volume, it is possible to add a prosthesis implant, in other words, to perform an augmentation mastoplasty and a mastopexy in the same operative session. In these cases, the extension of the scar will be reduced proportionally to the volume of the prosthesis. A well-executed procedure does not limit the functionality of the mammary gland, nor does it prevent the execution of normal diagnostic procedures such as ultrasound, mammography or magnetic resonance. The operation is performed mainly under general anaesthesia as a day case or with a short hospitalisation.

Reduction mastoplasty

A particularly abundant breast can be corrected and brought back to a more natural volume and to a harmonic form through reduction mastoplasty. The cause of excess breast volume may depend on an increase in the adipose or glandular component or both. Women with particularly large breasts experience both psychological discomfort, due to excessive volume, and physical discomfort because of postural disorders that may in fact be caused by excessive weight in the mammary area over time. It can cause some backbone disorders with back pain and maceration of the skin in the inframammary fold. The procedure can be performed using different techniques so it is good practice to consider how best it suits each patient. A reduction mastoplasty lasts between two and three hours and is usually performed under general anaesthesia. Reduction mastoplasty involves a scar around the areola and a vertical one down to the inframammary furrow and then, depending on the techniques used and the volume to be removed, a possible third one that is more or less long in the same furrow.

Mastoplasty vision

The massive diffusion of breast implants in recent decades has produced the current steady growth in requests for consultancy for the clinical and diagnostic assessment of the implant and its possible replacement.

Mammary lipofilling

Lipofilling allows the modest volumetric filling of the breasts through the adipose tissue. The main indication remains the filling of localised areas such as volume deficits in the results of trauma or surgical interventions. It is performed as a day case under local anaesthesia with the possible support of a sedation.

SURGERY FOR BALDNESS

Autologous hair transplantation

Autologous hair transplantation is a surgical procedure that allows hairless or thinned areas of the scalp to be thickened using hair roots taken from the areas where the hair is thicker and resistant to baldness. Androgenetic alopecia is the most frequent cause of baldness and affects men in almost all cases as a result of progressive atrophy of the hair roots due to the action of testosterone. In the posterior region of the nape and in the lateral zones of the skull, the roots have characteristics that do not undergo the hormonal action and its from these areas that the surgeon removes the hair to graft it into the thinning areas. The most advanced techniques allow individual follicular units to be transplanted in order to obtain a completely natural result. The surgeon and patient decide which technique to adopt to take hair for the autologous hair transplantation. The FUT technique involves the removal of a small portion of the scalp (strip) from the donor area from which to obtain the follicular units that are to be transplanted with the residue of a linear scar hidden in the hair. The FUE technique consists in the direct extraction of individual follicular units. The same procedure is used for the reconstruction of the eyebrow arch following a traumatic event. Autologous hair transplantation is performed as a day case under local anaesthesia with possible mild sedation to increase patient comfort.

RECONSTRUCTIVE PLASTIC SURGERY

Scar revision

The surgical or laser revision of pathological or unsightly scars allows the improvement of results of trauma often due to causes after which it was not immediately possible to manage the repair process in the best possible way. Depending on the case, it is possible to resort to different approaches such as skin plastics or patches up to the use of skin expansion techniques or tissue engineering.

Exeresis of skin and soft tissue neoformations

The plastic surgeon performs the surgical removal of skin and soft tissue lesions to be followed up by histological evaluation. If the size of the lesion does not allow direct suture, the affected area is repaired by plastic with a dermo-epidermal graft or by reconstruction with skin flaps. Oncological surgery procedures are generally performed under local anaesthesia or sedation, on an outpatient or day-hospital basis, depending on the individual clinical case. When histological examination is not envisaged, it is sometimes possible to use laser assisted procedures.

Conservative onychectomy

The surgeon treats nail pathologies with a surgical approach and with conservative techniques. These are performed as an outpatient procedure and under local anaesthesia.

Correction of palpebral ptosis

The palpebral ptosis is a lowering of the eyelid and is either congenital or acquired, which does not allow an adequate exposure of the iris. Correction of ptosis is performed by intervening directly on the elevating muscle of the upper eyelid or through a suspension to the frontal muscle. Depending on the case, these procedures can be performed under local anaesthesia or under sedation as a day case.

Entropion or ectropion repair

These are conditions in which the eyelid margin is rotated outwards (ectropion) or inward (entropion) causing deformity of the eyelid and frequent conjunctivitis phenomena. The correction procedure allows the restoration of the correct adhesion of the eyelid to the eyeball. The most appropriate technique is established on the basis of the individual clinical case and the nature of the problem. The operation is generally performed under local anaesthesia in an outpatient or day hospital setting.

Septoplasty and turbinoplasty

It is an intervention performed with a traditional or endoscopic technique with the aim of improving the respiratory function by correcting septal deviations and reducing turbinate hypertrophy. The procedure is carried out in sedation or under general anaesthesia as a day case and can be associated with an aesthetic rhinoplasty.

Breast reconstructive surgery

Breast reconstructive surgery employs multiple techniques that are frequently combined with specific strategies for each clinical case. Through lipofilling, it is possible to correct minor and medium-sized defects of the breast profile such as depressions, furrows and modest volume deficits. The technique involves the removal of the adipose tissue of the patient by liposuction and the subsequent implant with microcannula. Due to the partial resorption of the grafted adipose tissue, it may be necessary to repeat the procedure several times. The procedure is generally performed under local anaesthesia or under sedation. Nipple reconstruction following a mastectomy is performed with small skin flaps arranged at the top of the breast mound. The procedure is performed under local anaesthesia as an outpatient procedure. The total breast reconstruction procedure is performed with the preliminary use of a skin expander and its subsequent replacement with a breast implant. It therefore involves two surgical procedures. In the first operation, the cutaneous expander is inserted through the same incision of the mastectomy below the skin and the pectoralis major muscle. The expander is subsequently inflated gradually with physiological saline solution by weekly injections and after about two months from the achievement of the established volume and an adequate cutaneous distension is obtained, it can be removed and replaced with a definitive breast implant in silicone gel. Often, to obtain a satisfactory result, it may be necessary to reshape the contralateral breast by breast reduction, breast lift or breast augmentation with prosthetic implant. The procedures for insertion of the breast expander and the subsequent replacement with the final prosthesis are carried out under general anaesthesia.

PRP (platelet-rich plasma)

PRP is the acronym of platelet-rich plasma and is used in reconstructive surgery mainly in the treatment of difficult wounds. A modest amount of blood taken from the patient is centrifuged in order to eliminate the corpuscular part and to maintain the plasma with the platelets, which are used for the beneficial effects of their growth factors.

FACIAL AESTHETIC MEDICINE

Filler

The term ‘filler’ refers to those substances which, introduced through a needle in the skin or immediately below it, have the purpose of ‘filling’ the tissues. The main use of these products is for aesthetic purposes. Fillers are widely used for the correction of wrinkles, furrows or depressions of the face or simply to increase the volume of some anatomical areas such as lips or cheekbones. The active ingredients of fillers are numerous but, for purposes of simplicity, we divide them into two large families: resorbable substances and permanent substances. The resorbable fillers are the most widespread biomaterials as they are characterised by a greater ease of use, a greater naturalness and fewer complications. The main elements of this family are hyaluronic acid and hydroxyapatite. The treatment is performed once or twice a year and is practically free of contraindications except for the proven allergy to the product. Permanent fillers, as the name suggests, once injected into the body, are, at least in theory, perennial. This assumption brings advantages and disadvantages. The advantages are linked to the fact that the patient is subjected only once to the implantation of the substance while the disadvantages are related to the inevitable risks that the introduction of these materials causes. If fact the body recognises them as extraneous and tries to eliminate them by triggering a continuous inflammatory reaction at the site of the implant. Another thing that should be remembered is that the physiognomy of the face and body evolves with advancing age and the injected filler, if permanent, does not always follow the processes of tissue ageing in a harmonious way, and there is a risk that it may turn into a blemish after some years. The parent substance of this family, which is no longer in use, was liquid silicone and today its successors are products based on polyacrylamide. Sometimes the use of fillers is not only indicated in facial beautification therapies, in fact, even reconstructive surgery has made use of these products to fill tissue deficits caused by loss of substance deriving from trauma or congenital malformations.

Botulinum toxin

Botulinum toxin is a protein produced by a microorganism and medicine uses its paralysing power as an active ingredient in a drug used for the treatment of numerous diseases such as strabismus, blepharospasm and some forms of spasticity. When using botulinum toxin for these purposes, it was noticed that the wrinkles in the areas where the drug was used were reduced, so that, after further studies and clinical trials, it was also used for aesthetic purposes. Some face wrinkles are real lines of expression as they represent signs on the skin of continuous facial contractions, so it is evident how a partial and selective reduction of some muscles can induce a progressive regression of these wrinkles. The areas of the face that most benefit from the botulinum toxin are the forehead and the contour of the eyes but, in expert hands, it can also be used in other areas of the face such as the contour of the mouth, chin and neck. It is justified to think that a reduction in the motility of mimic muscles can reduce the patient’s expressiveness, but it will be the doctor’s job to make sure that all this does not happen. On the contrary, the facial expression can be improved in many cases. It is not a definitive treatment because, after a few months, the muscles resume over time the normal activity they had initially. Its effect is not immediately visible but the action begins to manifest itself after a couple of days. It is a treatment for both sexes and in every age group with very few contraindications and limitations. In fact, it is one of the most widespread cosmetic medicine procedures in the world.

Biorevitalization

Ageing of the skin is linked on one hand to constitutional factors (chronoaging) depending on the normal biological involution process that characterises all our tissues and, on the other hand, is influenced by environmental factors such as exposure to ultraviolet rays (photoageing), smoking, dehydration, inadequate cosmetic protection, wrong nutrition and stress. Over time, the skin undergoes changes in its formation that lead to the appearance of spots, loss of elasticity, thinning and dryness. The patient complains of less toned and dull skin and observes the gradual and unstoppable appearance of superficial and medium depth wrinkles. Antiageing medicine has studied pharmacological protocols of biostimulation and biorevitalization to reduce, limit and prevent skin ageing. The assumption of the use of these products provides multiple fronts of action including hydration, the reintegration of the lost skin constituents and stimulation of the cells responsible for the production of collagen. From a pharmacological point of view, the active ingredients most used in aesthetic medicine for this purpose are hyaluronic acid, vitamins, amino acids, coenzymes and minerals, glucosamine sulfate, pyridoxine, phospholipids, amino acids and polydioxyribonucleotide. The aesthetic doctor performs micro injections in the most superficial layers of the skin with a frequency dependent on the needs of the individual patient. There are many areas of interest: the face, the hands, the neck, the décolleté or where it is needed.

PRP

PRP is the acronym of platelet-rich plasma and is a technique used in aesthetic medicine for the rejuvenation of skin tissues. The platelets are among the essential constituents of the blood and their main function is haemostatic, that is to stop the loss of blood following small lesions allowing the start of the wound repair processes. Besides the coagulation potential, the platelets contain granules rich in substances essential for the repair and regeneration processes that are defined as growth factors capable of promoting important biological processes such as angiogenesis, that is the formation of new blood vessels, the migration of macrophages and the proliferation of fibroblasts with production of collagen and hyaluronic acid. For many years, the regenerative properties of platelet growth factors have been utilised in orthopaedic surgery, maxillofacial surgery and in dentistry and in plastic surgery for the treatment of chronic skin ulcers. More recently, aesthetic medicine has also used this technique in some skin biorevitalization protocols. After having performed a simple blood collection, the blood is centrifuged in suitable times and ways to obtain the separation of the corpuscular component containing red and white blood cells from the liquid component containing plasma and platelets. This fraction is injected with micro needles into the dermis of the areas to be treated. The anatomical districts interested in skin rejuvenation with PRP are the face and the neck with the décolleté. A session lasts from 15 to 30 minutes depending on the extent of the areas to be treated and is performed 2 or 3 times a year alone or in association with other biorevitalization methods with a protocol depending on cutaneous chronoaging.

Laser resurfacing

Fractional lasers are used, that is devices that allow the laser radiation to be distributed selectively on the cutaneous surface. This made it possible to substantially reduce recovery times and sequelae. The laser beam produces micro ablation channels that stimulate the neo-regeneration of the skin, giving the patient much more thick and luminous skin. It is possible to reduce and later eliminate skin imperfections such as wrinkles or scars. The laser at our disposal is the YOU LASER MT (Quanta System), which is able to combine two wavelengths: 10600 nm (carbon dioxide) and 1540 nm (Erbium Glass) in a fractional or sequential emission (Mixed Technology). The imperfections associated with skin ageing, such as wrinkles and pigmentations, as well as scars, can be effectively treated with this technology. The synergistic use of the two wavelengths allows to achieve visible improvements even after only one session, with minimal discomfort for the patient. Laser treatments generally last from 10 to 40 minutes, depending on the clinical condition. Usually, as in the case of scars or wrinkles, one or two sessions are required. The final results are visible no earlier than 2-3 months.

Vascular laser

Two-wavelength lasers are used for the treatment of vascular cutaneous lesions: 755 nm long pulse alexandrite and 1064 nm neodymium laser: Long and short pulse YAG. The combination of two wavelengths (755 and 1064 nm) in a single simultaneous or sequential emission allows the removal of neoplasms of vascular origin such as angiomas or capillaries.

Peeling

Peeling is a regenerative technique of the skin that is carried out with topical application of irritating chemicals. Depending on the needs of the patient and individual anatomical variability, different acids are used, with concentrations and application times that can be modulated (glycolic acid, trichloracetic acid, salicylic acid, phenol or peeling composites). Peeling is a term that indicates exfoliation of the skin induced by the application of a chemical substance. In aesthetic medicine, peeling is a regenerative technique of the skin. The functioning of a chemical peel includes some specific mechanisms of action, typical of the different substances used, and a common method of action. Exfoliation involves the removal of the most superficial horny layer, eliminating all the skin problems present at this level, such as slight hypercromies or keratoses of modest size. Furthermore, chemical aggression induces an increase in cell turnover and an inflammatory reaction that stimulates fibroblasts to the production of collagen and elastin. The intensity and duration of the exfoliation are dependent on numerous factors such as the type of substance used, its concentration, the application time and the characteristics of the patient’s skin. The more aggressive a peeling is, the more aftertreatment will be involved, from a banal exfoliation to scabs for deep peels. In relation to the aggressiveness of its components peelings are classified into superficial, medium and deep for simplicity but there are currently many substances in use: glycolic acid, trichloroacetic acid, salicylic acid, pyruvic acid, phenol and many others solutions that include a set of more chemical agents. A peel can be indicated for skin rejuvenation or for the correction of some problems such as keratoses, dyschromia or post-acne scars. It is up to the doctor to evaluate the patient’s request and after having carefully evaluated the skin, if there is an indication, direct them towards the most suitable therapy.

Needling

Needling is a regenerative dermatology technique born a few years ago that consists in treating the skin with special micro needles in order to induce a cellular stimulus that increases the production of collagen and elastin. Originally, needling was performed by the doctor through a roller (dermaroller) equipped with micro needles and manually scrolled repeatedly in the areas to be treated. In the modern version, an electromedical device is used that accurately modulates the depth of action, the penetration vector and speed. Compared to the old devices, the advantages are that the extreme speed of vibration makes the procedure painless and the control of the penetration vector allows a homogeneous and effective treatment. The mode of action of needling is based on the cell stimulation of the epidermis and of the dermis as a result of which coagulation factors and inflammatory cytokines are released, which induce an increase in the production of new collagen and elastic fibres. The skin regenerates and becomes more turgid with a clear reduction of the finest roughness. In aesthetic medicine, skin needling is one of the possible treatment tools for the reduction of photoaging and chronoaging skin damage. Its more specific functions include the treatment of post-acne scars, stretch marks and the most hostile wrinkles of the upper lip and the décolleté. The treatment is performed in the clinic with the support of a topical anaesthetic and the session has an indicative duration of 15 minutes and leaves redness at the end of the session which lasts a few days.

COSMETIC SURGERY OF THE BODY

Mesotherapy

Mesotherapy or district intradermotherapy is the local administration of a drug through injections into the dermis made with very small needles. The treatment is carried out in the area where the drug must be effective, thus preventing its diffusion at the systemic level and different active ingredients are used depending on the desired therapeutic effect. Mesotherapy in aesthetic medicine is a procedure indicated mainly in the treatment of cellulitis in the early stages of development with phlebotonic drugs for the improvement of the microcirculation or fibrinolytics to reduce the fibrosis of the tissue.

Carboxytherapy

It is a medical therapy that involves the introduction of gaseous carbon dioxide into the subcutaneous tissue. This administration takes place through a special instrument that modulates the gas flow, controlling its speed and quantity. Due to a paradoxical effect, carbon dioxide stimulates the flow of arterial blood at the level of the microcirculation and therefore the oxygenation of the tissue.

Intralipotherapy

It is a technique that uses needles or microcannulas to inject lipolytic drugs into the adipose tissue that are intended to decrease the volume of the panniculus adiposus.

Skin tightening

Improvement of skin tone through laser-assisted method or bio-revitalizing threads.

Laser tatoo removal

For the removal of tattoos, we mainly use the Q-Switched Nd:YAG laser, which produces laser pulses that break up the coloured pigments of the tattoo, which are in turn reduced into particles so small that they can be disposed of by the body. The laser beam recognises the colour so it is essential to use a laser of a wavelength suitable to hit the specific colour of the tattoo. In this regard, remember that some colours, such as yellow and green, are resistant as there is no instrument with adequate wavelength. The treatment is performed under topical anaesthesia with application of an anaesthetising cream on the part to be treated 30 minutes before the session, which lasts depending on the extent of the tattoo. After the session, a medication is applied for a few days and sun exposure should be completely avoided for a few weeks. After thirty or forty days from the session, the treated skin will be completely reconstituted with evidence of a more faded colour tattoo and the patient is now ready to undergo a new treatment. The number of sessions depends on many factors such as colour, the type of pigment, the intensity of the colour itself, the depth in the context of the skin and the anatomical area of interest.

Laser hair removal

Currently, the removal of unwanted hair from the body is a worldwide trend and laser photoepilation or other technology based on light is one of the most requested procedures in aesthetic medicine. The mechanism of action of laser epilation is based on the principle of selective photothermolysis. The main chromophore, i.e. the optical target of the laser, is the melanin of the hair follicle, which is concentrated at the level of the bulb and stem, structures that act as optical lures for the light ray. However, the biological target is represented by the stem cells located at the level of the follicular papilla and those present in a structure called bulge attached to the hair. These cells, unpigmented, continuously renew the growth of hairs during life. Basically, the laser beam on the skin is absorbed by the melanin of the hair, the light is transformed into heat and this thermal effect indirectly overheats the noble structures of the hair that are altered until they are totally destroyed. Only in this way is the hair cycle blocked and epilation can be considered really effective. Selective photothermolysis depends on numerous laser parameters that the medical operator manages including the wavelength, the pulse duration, the energy density, the size of the emission spot. If properly combined, all these measures confine the heat in the target chromophore by destroying it selectively and avoiding the dissipation of heat to the surrounding tissues, thus preventing unpleasant side effects. So there are some key factors for the success of an epilation treatment that go from understanding the anatomy, growth and physiology of the hair, a thorough understanding of the laser tissue interactions and the correct selection of the patient, which must be based on the assessment of the skin phototype, the extension of the surface to be treated, the evaluation of the colour and diameter of the hair to be removed. These last aspects will help decide the laser source to be used, provided they are all available to the doctor. The laser physician who deals with epilation uses different sources at different wavelengths (Alexandrite long pulse 755 nm, Neodymium: Yag long pulse 1640 nm, diodes 800-810 nm) to ensure the best possible treatment efficiency.

Intense pulsed light

Intense pulsed light (IPL) is a device that emits non-laser, non-selective high intensity light. One of the latest generation of medical technologies (SWT: selective waveband technology) allows you to obtain highly selected wavelength ranges, eliminating unnecessary ones and reducing the use of high fluences, thus minimising side effects. The range of possible treatments at the face level is vast. Depending on the selected wavelength range, it is possible to perform an innumerable quantity of aesthetic interventions including: elimination of solar lentigines (skin spots), photorejuvenation (facial skin lightening and improvement of the skin texture), treatment of telangiectasia, rosacea, couperose, flat angiomas, venous lakes (vascular neoformations often present in the mucous membranes of the lips) and some cicatricial outcomes. Even at the body level, there are many indications on the use of pulsed light and photoepilation certainly deserves a prominent place: the possibility to modulate the pulse length and the selectivity of the wavelengths allows to obtain excellent results, achieving good results also in darker skin types and in the presence of non-optimal hair targets. Other therapeutic possibilities involve the photorejuvenation of hands and Colette, the treatment of stretch marks, of some cicatricial outcomes and, in selected cases, some types of telangiectasia of the lower limbs.

Cryolipolysis

The cooltech cryolipolysis is a recent method that exploits the specific physical properties of fat with respect to neighboring tissues, thus inducing a selective removal of the same. It works by combining the vacuum effect with the controlled cooling of the treated area, thus operating a reduction in the fat cells of the worked body area. The body areas subject to therapy are: Chin, Arms, Abdomen, back, hips, trochanters, inner thigh, medial knee area. The machine is equipped with different ad hoc shaped handpieces to ensure greater efficiency and safety in “pinching” and cooling the adipose tissue. The therapy lasts about 70 minutes, two areas of the body can be treated simultaneously, it is not painful and sometimes patients relax until they fall asleep. the area may show mild erythema lasting from minutes to hours in the aftercare, small occasional bruises associated with the aspiration process and reversible alterations in local skin sensitivity. The number of treatments varies from a single session to a maximum of three sessions. The results of the treatment begin to be felt after 40 days with consequent improvement in the following months.