How many times a rhinoplasty surgeon hears these words from a patient who is dissatisfied with the outcome of the rhinoplasty operation he underwent! In the international cases of the best surgeons the incidence of imperfect results varies between 5% and 9%. On the other hand, any plastic surgery can include subsequent improvement, and rhinoplasty is of course no exception. Even more so when rhinoplasty is a secondary or revision. But what exactly do these terms mean? We ask this to dr. Sebastiano Sciuto, one of the most experienced Italian rhinoplasty surgeons, with thirty years of experience in the field, co-founder of the AICEFF (Italian Association of Aesthetic and Functional Surgery of the Face) and of the Italian Academy of Rhinology, member of the European Academy of Facial Plastic Surgery.

Dr. Sciuto, a professional life dedicated to rhinoplasty.

That’s right: the main field of my professional interest in the last thirty years has been nose surgery in all its aspects, with the main objective of achieving the difficult and delicate balance between functionality and aesthetics. I was among the first to apply the surgical technique of endoscopic nasal surgery, which allows to intervene passing inside the nasal cavities without operating any type of external cut, significantly reducing healing times.

Every three years I direct Naso & Dintorni, an international course in nose and face surgery, a very interesting and fundamental opportunity for exchanging professional and human experiences, to which, from 1993 (first edition) to today, hundreds of surgeons participated Italians and foreigners. I performed thousands of primary and secondary rhinoplasty operations. Yes, we can say that the nose is my professional “obsession” (smiles).

Everyone knows more or less what a rhinoplasty operation is, but can explain to our readers what secondary or revision rhinoplasty is, a surgical practice in which you represent one of the Italian excellences.

Thank you for this definition; in fact I have gained a great deal of experience in this type of surgery, which is delicate from a technical but also a psychological point of view. In recent years, in fact, there have been growing cases of patients who turn to me because they are unhappy with the outcome of the rhinoplasty performed. Unfortunately surgeons with little specific experience in nasal surgery can cause serious damage to the nose of those who have relied on them with confidence. Attention, however: not always the responsibility of the patient’s dissatisfaction is due to a bad job of the surgeon. In fact, it may happen that the new nose does not correspond to the “imagined” one or that breathing difficulties persist due to the unpredictability of the healing process, which is never the same from patient to patient: the cartilage can flex, the bones can weld unevenly, the swelling can persist for a very long time and the final result may vary from person to person. Whatever the causes, those who are dissatisfied with their redone nose may decide to resort to secondary rhinoplasty. And here I speak.

Is secondary rhinoplasty more difficult for the surgeon and patient?

It is undeniable that operating a nose for the second time presents greater difficulties than doing it on one never operated before: it is as if someone had put inside the nose of the “glue” to make the skin adhere well to the bones and cartilages below. This “glue” is the scar tissue, which is very durable and should be treated with very cautious and careful maneuvers to avoid further damage. However, despite the technical difficulties of the intervention, certainly reserved for the most experienced surgeons, most patients benefit from revision surgery, especially those that have realistic expectations. The most serious surgeons do not operate if they are not convinced that an improvement is possible, but we must be realistic: most often the goal of secondary rhinoplasty is improvement and not perfection.

Therefore, dr. Sciuto, what advice can you give to those who are dissatisfied with their operated nose?

First of all, to wait patiently for the passing of time: before declaring oneself dissatisfied with one’s nose, it is necessary to let at least 10-12 months pass, so much for the tissues to heal and deflate definitively and thus assume a definitive and stable form and function, which can be appreciated or rejected.

In the second case it is absolutely necessary to contact an experienced surgeon, that is to say that he has experience gained by performing a large number of nasal surgical procedures: today in Italy there are few surgeons operating more than 50 noses a year, as in all there are few people in the world who work more than 100. It is better to rely on proven professional seriousness rather than the reputation gained on social and media.

One last curiosity, before leaving us: what does he do when he is not working?

My second passion after the nose (he still smiles) is the sea: as soon as I have a free moment I run away on my sailboat, between sea and sky. The beauty and perfection of nature are always a source of inspiration for my work and my life.

Interview with the lawyer G. Meglio on the damage caused and on the protections that can be activated

Asbestos is a natural mineral with a fibrous structure, with sound-absorbing and heat-insulating properties, which in the past, thanks to its low market cost, has had extensive and varied industrial applications, where there were needs for sound absorption and / or thermal insulation. Since the 1940s, based on exhaustive statistical reports and epidemiological surveys, the International Scientific Community has highlighted the danger of this material which is highly harmful to human health, both in relation to the risks of asbestosis (chronic respiratory disease) and of those carcinogens (respiratory neoplasms, pleural cancer, peritoneum, pericardium, asbestos-related lung cancer, bladder cancer). However, despite these indisputable scientific evidences, asbestos has continued for many years to be extracted, processed and used in multiple uses. “Public health was therefore sacrificed to the economic interests of the industries of the sector with a cynical calculation that, in addition to the very serious and irremediable damage to the health of the victims, had a significant impact on the economy of the entire country, due to the high costs relapses on the community for diseases, for social security and for reclamation works ”, Gianmarco Meglio affirms with emphasis. For years engaged in the defense of numerous former workers of the shipyards of Stabia and not only exposed to asbestos, thanks to his passion and determination, he obtained excellent results and substantial compensation for the damages suffered by relatives of the victims or by seriously ill workers.

When public opinion began to understand that exposure to asbestos could be extremely dangerous?

I would say that, unfortunately, public opinion perceived the danger of asbestos when it was too late and the first damages, especially in some industrial sectors, were already beginning to appear. We are talking about thousands of families undermined by the problem of the long-term damage, that is the manifestation of a disease at a distance of time, even considerable, compared to the exposure to the pathogenic element.

At a certain point, even in Italy, the institutions began to have this problem at heart, to try to repair a widely consumed wrong, since the political class of that time was not immediately incorporated the European prevention norms dictated in this matter since 1980. Today what charges are incumbent on the employer?

In our country, for several decades (until the early 1990s), an indiscriminate use of asbestos was made in violation of the provisions of the laws of prevention already in force. I refer to both the art. 2087 c.c. – according to which “the employer, in the exercise of the company, is obliged to take the necessary measures to protect the physical integrity and the moral personality of the workers” – that in art. 21 of the D.P.R. 303/56 – a standard that aims to prevent diseases deriving from the inhalation of all dust (visible or invisible, fine or ultra-fine), and in accordance with which “in works that normally give rise to the formation of dust of any kind, the employer is required to take measures to prevent or reduce the development and spread in the workplace, taking into account the nature of the dust and its concentration in the atmosphere “. In practice, in the exercise of the working activity, the entrepreneur is required to adopt preventive and protective measures of a technical, organizational, procedural and hygienic nature suitable for protecting the health of workers.

In the course of her long professional activity, she has spent a great deal of time legally assisting former shipyard workers, places where asbestos was used massively up until the 1990s. Considering that the disease has an incubation period of 30-40 years, it is easy to deduce that unfortunately the peak of mortality will occur around 2020. So, what can these poor people exposed to them, in spite of themselves, this killer material?

First of all, monitoring of one’s health and prevention: regularly undergo specific medical checks. For many years in the mechanical naval industry – think of the yards of Castellammare di Stabia, Monfalcone, Ancona, La Spezia, and Palermo – it has been made “a disproportionate use of this mineral” used in all the works of insulation of the ships until, at starting around ’92, its production and processing has been banned with the introduction of law number 257. In the meantime, however, hundreds of workers have become ill with asbestosis (shortness of breath, chronic cough, wheezing) and pathologies oncological, incurable diseases caused by the inhalation of asbestos fibres. Many of them have died over the years and many others suffer from severe respiratory disorders on a daily basis. In this context of pain and suffering, many former workers or their families have started legal actions, relying on experienced and qualified people who have been able to assert their rights for too long denied: substantial compensation, early retirement, compensation or annuities. My second suggestion is therefore to claim one’s rights by addressing, without fear, to highly specialized professionals; in general the consultancy is totally free with an overall assessment of the work history and the medical-legal situation.

More info: www.studiolegalemeglio.it

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Total hip replacement is one of the most successful and successful interventions in orthopedic surgery. Thanks to technological progress and scientific research, in recent years there has been on the one hand a significant improvement in surgical techniques, increasingly accurate and patient-sized, and on the other hand a significant evolution in the materials used to make orthopedic prostheses . And so, in response to the ever-increasing patient demand, minimally invasive surgery has been applied in recent years with extraordinary clinical results (reduced post-operative pain and rapid functional recovery) even in the orthopedic field. Today it is possible to implant a hip prosthesis without necessarily having to resort to high impact techniques, but more simply by using procedures that are more respectful of the anatomical integrity of the treated tissues. To illustrate the advantages of minimally invasive surgery in orthopedics are Dr. Daniele Patacconi and Dr. Roberto Lanzone of the Aurelia Hospital in Rome and N.O.C. of Ariccia (RM)

Dr. Patacconi, what does it mean in a specific mini-invasiveness?

Minimally invasive means operating bone or non-bone segments (for example cartilages, fibrocartilages, tendons or ligaments) without damaging the tissues that are not involved in the damage, thus causing the least possible insult to all healthy anatomical structures that must be crossed to reach that damaged. Following a multi-year and fruitful collaboration with dr. Etienne Peronne of Clermont Ferrand (FRA), Dr. Lanzone and I have devised a minimally invasive technique that allows a hip prosthesis to be implanted through an incision of only 5-7 cm, without any muscular section and resulting in a negligible blood loss. The by now proven mininvasive anterior approach is able to ensure excellent functional results to an ever increasing number of patients.

Dr. Lanzone, what advantages does this technique bring to patients?

It offers a series of numerous advantages: Respect for periarticular structures (Muscles, Nerves, Vases); reduction of blood loss; less post-operative pain; short hospital stay and recovery of functionality in a short time. The fast-track re-education path allows a rapid return to normal daily and sports activities; goal much sought after by increasingly younger, demanding and eager patients who want to resume their lifestyle as soon as possible.

For more info: www.newhip.it drpatacconi@gmail.com roberto.lanzone@gmail.com