05. Timedsurgical mixed peeling to correct skin defects caused by labiopalatoschisis
KEYWORDS: labiopalatosquisis, pulsed timedsurgical de-epithelialisation, Adipofilling, mixed peeling
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. A small incision is made in the anterior base of the wing of the nose and the area to be raised is dissected. An elastic surgical thread is used as a filler; thanks to its extreme biocompatibility, this thread can also be utilised as an implant. To raise the floor of the nostril and the wing of the nose, 1 m of EP 4 elastic thread has been implanted.Once the implant has been inserted and the structural deformity corrected, volumetric enhancement and biological revitalisation of the half-lip affected by the cleft are carried out. Adipofilling, which involves grafting adipose and stromal cells, is performed by means of a 1 ml syringe.
When the floor of the nostril and the wing of the nose have been raised and the volume and trophism of the half-lip have been improved by means of Adipofilling, timedsurgical mixed peeling is carried out a few months later. This enables the best possible result to be achieved in a single treatment session. Indeed, mixed peeling is the technique of choice for the elimination of even deep lip wrinkles.
In this case, our aim is to even out the surface of the skin of the lip. In this way, the previous congenital pathology and the artefacts of the surgical operation will no longer be visible.
Timedsurgical mixed peeling is carried out under loco-regional anaesthesia. Pulsed timedsurgical de-epithelialisation begins, as always, a few millimetres outside the nasolabial folds. Programme data: Direct Pulsed 4/900 of a second, Coagulation, 2 Watt, EM10 Yellow (edge of the angle).
The electrode skims the skin in small circular movements. Pulsed de-epithelialisation lifts the epidermis without damaging the dermal papillae and the capillary-papillary plexus. The entire surface of the lip is de-epithelialised, from the base of the nostrils and of the columella to a few millimetres inside the vermilion border.
Pulsed timedsurgical de-epithelialisation enables us to implement other interesting applications, such as the elimination of dermal-epidermal hyperpigmentations or the re-pigmentation of stable vitiligo. In this latter application, the achromic epidermis is replaced by a graft of autologous keratinocytes and melanocytes cultured from a 1 cm2 skin sample taken 20 days earlier.
Now, the same non-activated electrode is used to remove the epidermis, the thin transparent layer that covers the dermis. There is no bleeding, as we are above the capillary plexus. The fact that the dermis is not damaged enables the saturated solution of resorcin to be absorbed perfectly uniformly.
Application of the solution begins from the labial filter and progresses to the areas where there are wrinkles and the scars from the previous labioschisis procedures. The last areas to which the solution is applied are those at the sides of the wings of the nose, where there are no wrinkles. Application takes about a minute and a half. The saturated solution is immediately washed off. Immediately after washing, the lip is dried and an aqueous solution of cortisone is applied. The patient must not apply any creams or other products, but should simply dry the lip frequently with a paper tissue until a thin dry crust has formed; the crust normally forms after four or five hours.
As always, the result of the mixed peeling is optimal and the unsightly effects of the labiopalatoschisis procedure are no longer visible.
Capurro S. (2013): Timedsurgical mixed peeling to correct skin defects caused by labiopalatoschisis. CRPUB Medical Video Journal. Other techniques section. http://www.crpub.org
The extraordinary efficacy of timedsurgical mixed peeling in eliminating the unsightly effects of labiopalatoschisis procedures is clear. However, what advantages does it have over laser treatment, apart from the obviously superior aesthetic result.
The drawback to using lasers in dermatological and aesthetic procedures is that light travels in a straight line at a speed of 300,000 km per second. This causes unwarranted damage to the superficial tissues. By contrast, a high-frequency current travels over surfaces, enabling the integrity of the deep tissues to be maintained. At a high power, it can therefore vaporise achromic patches, scars, etc, without side-effects. However, mixed peeling is a physical-chemical technique. That the chemical effect is greater than the physical effect is evident both from the results and from their persistence over time. Pulsed timedsurgical de-epithelialisation (a physical technique) enables us to standardise the procedure and to utilise a chemical substance that does not produce any effect on integral skin, but which, if applied to an intact dermis, is perfect for the elimination of even deep wrinkles. A burnt or dehydrated dermis would prevent the resorcin solution from penetrating properly. The resorcin reorganises the connective fibres and the lip is shortened. The pores of the skin return to their native state and blemishes disappear. Moreover, resorcin does not engender risks of hyperpigmentation. Last but not least, there is the question of cost. Timedsurgery is extremely economical and enables 72 different applications to be implemented. Lasers, as we know, are extremely costly and their efficacy is poor. In conclusion, mixed peeling is the technique of choice for the elimination of lip wrinkles and the consequences of labiopalatoschisis.
Can timedsurgical mixed peeling be carried out on other regions of the face?
It can be used to treat the eyelids and crows’ feet. In this case, the saturated solution of resorcin is diluted to 50% and application lasts only a few seconds. This treatment is carried out only in selected cases.
Can it be used on the whole face?
Wrinkles on the cheeks are caused by gravity and can be eliminated by means of elastic MACS lifting. The quality of the skin can be improved by means of Electroporo-Cosmesis, followed by the application of resorcin. In the same session, several repetitions of treatment (Electroporo-Cosmesis and resorcin) can be carried out, if necessary.
The visible effects of labiopalatoschisis operations can be corrected by means of three techniques: Adipofilling (increased volume and trophism), implantation of the Elasticum® thread (correction of the floor of the nostrils) and timedsurgical mixed peeling (attenuation of skin scars). These three techniques, either together or separately, correct the defects that may remain after labiopalatoschisis operations. Defects involving the wings of the nose are corrected by means of the usual cartilaginous grafts or flaps. A particularly interesting possibility is that of correcting bone deficits by implanting the elastic thread (11 Elastic Plastic Surgery).