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The superficial injection needling botulinum (SINB) technique is the dermal injection of microdoses of botulin toxin, not by traditional syringe but with needling technique that consists in multiple microdroplets by electrical device. The intention is to decrease sweat and sebaceous gland activity to improve skin texture and sheen and to target the superficial layer of muscles that find attachment to the undersurface of the dermis causing visible rhytides. The technique is for treatment of face and neck by the injection of the botulin toxin into the dermis or in subdermal plane to improve skin texture, smoothen horizontal creases, and decrease vertical banding of the neck as well as to achieve better apposition of the platysma to the jawline and neck, improving contouring of the cervicomental angle. The botox solution is hyperconcentrated when compared to traditional dilution or compared to microbotox or mesobotox. Furthermore, the injection technique is different because spreading superficial microdroplets are not performed, but small, homogeneous, and controlled amounts of solution are injected. Each 0.8-mL syringe contains 50 units of onabotulinumtoxinA. The solution is delivered intradermally, using an electrical needling pen and setting the depth penetration of the needles at 3 to 3.5 mm. The 2 conjugated techniques play a 2-fold action on the skin. The technique was applied to a group of 63 patients dealing with face, forehead, cheekbones, and neck.

Background: To develop and validate a questionnaire for the screening of Vitamin D in Italian adults (Evaluation Vitamin D dEficieNCy Questionnaire, EVIDENCe-Q). Methods: 150 participants, attending the 11Clinical Nutrition and Dietetics Operative Unit, Internal Medicine and Endocrinology, Istituti Clinici Scientifici Maugeri IRCCS, of Pavia were enrolled. Demographic variables and serum levels of vitamin D were recorded. The EVIDENCe-Q included information regarding factors affecting the production, intake, absorption and metabolism of Vitamin D. The EVIDENCe-Q score ranged from 0 (the best status) to 36 (the worst status). Results: Participants showed an inadequate status of Vitamin D, according to the current Italian reference values. A significant difference (p < 0.0001) in the EVIDENCe-Q score was found among the three classes of vitamin D status (severe deficiency, deficiency and adequate), being the mean score higher in severe deficiency and lower in the adequate one. A threshold value for EVIDENCe-Q score of 23 for severe deficiency, a threshold value of 21 for deficiency and a threshold value of 20 for insufficiency were identified. According to these thresholds, the prevalence of severe deficiency, deficiency and insufficiency was 22%, 35.3% and 43.3% of the study population, respectively. Finally, participants with EVIDENCe-Q scores <20 had adequate levels of vitamin D. Conclusions: EVIDENCe-Q can be a useful and easy screening tool for clinicians in their daily practice at a reasonable cost, to identify subjects potentially at risk of vitamin D deficiency and to avoid unwarranted supplementation and/or costly blood testing.

Its open-label design and small sample size notwithstanding, this study indicates that intradermal therapy, according to the recommendation of the Italian Society of Mesotherapy, may provide a valuable contribution to the treatment of CVI and related fibrosclerotic edema of the subcutaneous tissue by prolonging the local effect of the pharmacologically active compounds. Comparative studies are needed to identify the broader clinical and economic benefits of local therapy compared with other systemic therapies.

INTRODUZIONEMolti inestetismi del viso possono essere corretti impiantando nel derma o nel sottocutaneo prodotti di origine biologica o sintetica denominati "filler". Queste sostanze hanno simili finalità terapeutiche, ma differiscono molto tra loro per caratteristiche biologiche e chimico-fisiche. L'American Society of Aesthetic Plastic Surgery (ASAPS) ha stimato nel 2004 circa 12 milioni di interventi estetici (2,1 milioni di tipo chirurgico e 9,7 milioni di tipo non chirurgico), dei quali quasi 900.000 riguardavano l'uso di sostanze per aumentare il tessuto sottocutaneo [1][2][3][4]. L'esigenza del mercato di offrire dei filler per impianti sempre più duraturi ha provocato l'immissione sul mercato europeo di numerosi prodotti, tutti regolarmente registrati con marchio CE, composti da sostanze pressoché non metabolizzabili dall'organismo ospite. Tali filler avrebbero dovuto rispettare le norme generali di assoluta sicurezza per i pazienti, ma hanno dato numerosi effetti collaterali e complicanze più o meno importanti, legate alle caratteristiche chimico-fisiche e immu- nologiche della sostanza iniettata, alle modalità di iniezione e alla risposta dell'organismo ricevente. Da qui è nata l'esigenza di avere delle linee guida condivisibili dalla maggioranza degli operatori del settore che avessero come scopo principale quello di fornire un ausilio professionale, elevando il livello di qualità della prestazione resa [1,[5][6][7][8][9].La stesura di linee guida per l'uso dei filler mira a fornire un ausilio professionale, elevando il livello di qualità della prestazione resa, ma nel contempo si prefigge di rendere compartecipi delle finalità e della complessità della procedura i pazienti e i non addetti ai lavori La redazione delle linee guida ha impegnato un Comitato composto da: Nicolò Scuderi, Carlo Alberto Bartoletti, Giuseppe Micali, Paolo Silvestris, Pierfrancesco Cirillo, Emanuele Bartoletti, Maurizio Benci, Carlo Bertana, che hanno coordinato la Consensus Conference Italiana sui Dermal Filler, ABSTRACTThe presence of a lot of dermal fillers for aesthetical use and many adverse events has made necessary an accord of guidelines, among the experiences of the experts about use of this devices, that concerned the ideal characteristics of a filler, the criteria of choice (anatomical area, type of aesthetical defect ), the consolidate procedural habits, the legal aspects (clinical chart and informative consent), the behaviours in the different anatomical zones.