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08. Otoplasty: Concha Reduction & Antehelix Shaping with U-Stitches

Prominent ear deformity is the most common abnormality of the external ear. Over 200 different techniques have been described to correct this deformity.

The concha reduction is performed with an incision on the external side of the ear. Once the cartilage is incised, the perichondrium is detached, and a strip of cartilage is removed as wide as desired to reduce the protrusion of this part of the ear.

The antihelix is modeled percutaneously. The perichondrium is incised with a 21-gauge needle and the cartilage is weakened. The antihelix cartilage can also be weakened with Stenstrom rasps through the conchal incision or with a rotating micro rasp.

The weakened fold of the antihelix is maintained with two 4-0 polyester U-shaped sutures placed with two 18-gauge needles. The visible result is natural and the ear shows no trophic deficit.

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07. Complete ambulatory removal of a sacro-coccygeal cyst and immediate skin suture

In the event of recurrent infection, pilonidal or sacro-coccygeal cysts must be completely removed, and the skin must be sutured. No curettage, laser therapy, phenol treatment, endoscopic procedures or operations that cause an open wound should be carried out. Indeed, a sacro-coccygeal cyst can be completely removed, and the skin sutured during an ambulatory session, enabling the patient to go home immediately. No drainage is required. No recurrence of the cyst  Healing is perfect.

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06. Volumetric revitalisation by means of Macrolane VRF 20 and VRF 30

Revitalisation of the skin and subcutaneous tissues is carried out by means of cross-linked hyaluronic acid. As non-cross-linked hyaluronic acid spreads very easily, it does not exert a local revitalising effect, but disperses very rapidly in the organism.
For volumetric revitalisation, we use Macrolane VRF 20 and VRF 30 (Q-Med AB, Uppsala, Sweden), a biodegradable, biocompatible, stabilised gel of non-animal origin.
The material needed in order to carry out suspension for volumetric revitalisation is what you can see: two 20 ml syringes, Macrolane VRF 20 and VRF 30, 10% glycerol, lactate Ringer solution or physiological solution, a 1 ml syringe, 4 mm-long 27 G needles and 2% lidocaine.
A connecting tube is also needed in order to transfer the material utilized from one syringe to the other.

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05. Timedsurgical mixed peeling to correct skin defects caused by labiopalatoschisis

The surgical correction of a cleft palate often leaves visible defects of the skin, which constitute a handicap in the patient's personal relationships. In this patient, the skin alterations are particularly marked and the scar left by the surgical correction is clearly visible. Moreover, a small angioma can be seen close to the vermilion border. Another evident deformity has been caused by the lowering of the floor of the nostrils as a result of the cleavage of the bone.

In order to achieve a good result, each individual defect must be corrected. A slight correction of the vermilion border has been made. Now, the floor of the nostrils is to be raised.

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04. Vertical Spolidoro's mastopexy

This procedure, which used to involve implementing Schwartzman’s manoeuvre, was later modified through the introduction of de-epithelialisation of the area of skin removed. Recently, in order to improve the quality of the periareolar scar, round block has been performed with the elastic thread (Elasticum® Korpo SRL) equipped with a two-tipped needle.
While the patient is standing, a landmark point is marked on the jugular; another two points are then marked, one on either side of the landmark point, at a distance of 4 cm. From each of these two points, a line is drawn which runs over the nipple and down to the inframammary sulcus. Two points are then marked on each line at 18 cm and 20 cm from the jugular. The midsternal line and the inframammary sulcus are drawn. A circle of 4.5 cm in diameter is used to draw the areola, which will be reduced. The skin shield in the lower portion of the breast is determined by pinching the breast with four fingers.

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03. Widened hemi-areolar access in additive mastoplasty

Often, because of the small dimensions of the areola it is not possible to insert mammary prostheses through a lower hemi-areolar incision. This means that an alternative access must be used, for example, the inframammary fold, which is not always welcomed by patients or surgeons. This problem can be overcome by increasing the size of the areolar access without compromising the final result of the scar from the wound. The procedure consists of lengthening the peri-areolar incision in the mammary skin, at 3 o’clock and 9 o’clock, to form a 30° angle opening out towards the bottom. This simple procedure increases the access by approximately 4 cm, allowing easier insertion of the prosthesis. The two small triangular skin flaps are removed and suturing restores the regularity of the access borders.