• Sun. Nov 28th, 2021

Story of Chiara the surgeon, a facial muscle bears her name

Byeditorial

Oct 23, 2021

For years it has been a ‘no man’s land’, an unknown no man’s land. Today it bears her name: Chiara’s fascia. But she, Chiara Andretto Amodeo, is not an explorer, but a plastic surgeon. And the land conquered after a decade of studies invested to discover it, describe it, know its qualities, is not somewhere in a remote corner of the globe, but on the face of all of us. “We have demonstrated the existence of a fascial structure, a deep fascia that occupies the region of the middle third of the face, therefore below the eye in the cheek – explains the expert at Adnkronos Health – It has been histologically demonstrated that it is it is a deep fascia because it has been compared with other deep fascial structures of the head. And it corresponds, there is no doubt. It is a structure that protects the facial nerve, in particular the branch that goes to the mimic muscles that lift the lip “. Initially described as the “deep fascia of the infraorbital region that comes from the temporal fascia”, today it is simply Chiara’s fascia. The ‘baptism’ of the new name took place in an international context: the congress organized by the American College of Surgeons, Cosm 2021 (which brings together 9 scientific societies from the States), last April. Chiara, born in 1977, was the only Italian plastic surgeon to present a report. Since then there have been other congresses. The definitive consecration? End up in one of the anatomy ‘bibles’. The structures are often named after who described them. But it can take years, these are the laws of the ‘toponymy’ of the human body. Meanwhile Chiara has taken away a lot of satisfactions, even that of ending up with her band in a book of head and neck surgery. And to hear his name spoken around the world by foreign colleagues, in an Anglo-Saxon or French ‘modified’ version, (“ciara’s or ciahà’s fascia, but it’s worth it, it’s the content that counts”, he says). However, it was not easy to get here. “Much of the first phase of research was self-financed, I believed in it so much,” he recalls. The story begins with a thirty-year-old girl of high hopes born in Voghera (Pavia), who flies “to Paris where there is a very important school of anatomy at European level. At that time the funds were not great. Therefore, thanks to the participation of other figures professional, one professor rather than another, with conventions – says Chiara – I was able to have the material I needed for my studies, material that for an anatomist are obviously also corpses “. The scholar then found herself “celebrating with her friends that she had been able to dissect 10 for free”. “There are those who are enthusiastic about the designer bag, in those days I rejoiced to have been able to use material and work rooms for a fee of 5-6 thousand euros”, he smiles. Sacrifices ultimately bear fruit. “There have been important occasions – the surgeon continues – Just think that the medical-scientific society of which I have been a member for years, the Société anatomique de Paris, is the oldest on the planet”. And then came what Chiara calls the “mentor par excellence”: Gregory S. Keller, professor at the University of California, Los Angeles (Ucla): “It gave me the first chance to develop the work that brought me to where I am now. “. From that vision of a deep range where it was assumed that there was not, the specialist goes back, “an international study was born in which Italian, American and French colleagues participated both in the field of surgery, pathological anatomy and histology. these years we have presented the various stages of research in numerous congresses all over the world and signed many publications. At first we dedicated ourselves to anatomically defining the structure and its relationships with the adjacent ones, we have shown that this fascia takes part in the formation of some supporting ligaments of the face, we have described its relationship with the branch of the nerve that is located below and is protected by the fascia and also with the vessels and other anatomical structures “. In the meantime, Chiara continues,” the ‘surgical application in the aesthetic field, especially in facelifts, and there have been numerous publications on the fact that, leaving this structure in itself de, it is possible to perform safer detachment maneuvers. Considering that the nerve is protected, the tissues can be isolated and repositioned even in a more aesthetically pleasing and natural way. “Knowing how to manage Chiara’s fascia, continues her discoverer,” translates into a lower risk of nerve damage for patients. , which is the greatest risk in facelift procedures, and in a better result because the surgeon is allowed to work with a wider comfort zone. “” The choice of a slimmer name for the facility has only now come, after years of Education. Like any new scientific concept, it is brought to the appropriate venues that are congresses. And then there are the scientific publications. One with this name is ready. And another 2-3 are at stake. A further interesting development of the research concerns the application in the field of melanomas “, explains Chiara.” From the oncological point of view, “already in the late 1950s and early 1960s there were works that indicated the deep fascia as a safe reference plane. Therefore, except for specific cases, it is preserved, because it seems to protect against a risk of metastasis to the lymph nodes. This indicate the guidelines and applies to the whole body. But the piece of this region of the face is missing, which must be integrated – says the expert – with the certainty that here there is a deep strip and the demonstration that it is possible to preserve it as it is done with other areas “. “Before we described the structure – observes the surgeon – this part of the face was a bit of a no man’s land, it was the only part of the body where a deep fascia had not been described. Having shown that it exists is leading us to develop ‘application in the field of melanomas in this facial area, where previously the resection could go very deeply, involving those mimic muscles covered and protected by the fascia. This opens up the possibility of finding a surgical approach as conservative as possible that guarantees the same. result of the most destructive “. Chiara’s fascia was not a downhill path. “Often there is a fear of facing something that goes against acquired and long-standing concepts”, observes the specialist. Chiara happened to ‘break’ the audience: “A couple of professors replied that they had never seen this band, others replied that I deserved a doctorate”. And she unhurriedly earned the trust of the scientific community. “The important thing – he reasons – is to develop new acquisitions in the most serious way possible by bringing concrete evidence and data, and then to insist, because it is not certain that even with data and concrete evidence the concept is metabolized. Scientific activity is also based on this, and it takes time. Then comes the moment when the perspective changes “. For Chiara it happened in 2018, when she was invited to speak at the American Congress on plastic surgery in Chicago. “I felt comfortable with a parterre of prominent professors, because I brought bomb proofs,” he recalls. It had been some time now since her first congress as a speaker, the World Congress of Facial Plastic Surgery in Sao Paulo where she was “invited to speak for the first time. My baptism”, she calls it. who took her to Paris, to the Ecole doctorale Sorbonne Paris Cité, and then to Keller, who granted her a fellowship to develop her studies, asking her commitment in return. “I sent him long emails in which I tried to explain what I had seen. He understood immediately. And he supported me in these years of studies, he saw that what I proposed made sense and together we continued to develop it. Today we work and publish. together, overcoming time zones and distances “. And Chiara shares with her US colleagues involved in dissections what she has acquired over the long years of work, offering photos and instructions to isolate the fascia well. “There is a continuous exchange – he concludes – The research continues. And now we are many”.

One thought on “Story of Chiara the surgeon, a facial muscle bears her name”
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