17. Eliminating dark eye-rings with timedsurgical mixed peeling
KEYWORDS: dark circle, hyperpigmented dark circles, timedsurgical mixed peeling, timedsurgical de-epithelialization, xanthelasma vaporization, Timed apparatus, resorcinol
Timedsurgical mixed peeling eliminates dark rings from under the eyes. These dark rings are due to an increase of melanin in the dermis, which is sometimes accompanied by dilatation of the blood vessels. This esthetic defect is often congenital and familial.
Mixed peeling is so called because it is a physico-chemical procedure. Before beginning the procedure, the operator uses a dermographic pen to mark out the margins of hyperpigmentation of the lower eyelid.
Local anesthesia is carried out by means of epinephrine. The skin is pierced with a 21G needle. The operator then uses a 25G cannula, 7 cm in length, to distribute the local anesthetic beneath the skin of the entire hyperpigmented area.
Once local anesthesia is complete, a resorcin solution is prepared; a small amount of resorcin powder is placed in a small container and partially dissolved in a small amount of saline solution. After 10 minutes, a syringe is used to aspirate 1ml of this saturated solution, which is then diluted with 1 ml of saline solution, in order to create a 50% resorcin solution.
Pulsed timedsurgical de-epithelialization now begins. The Timed apparatus is set to the specific program: Direct Pulsed 4/9 hundredths of a second, Coag, 1 or 2 Watts, EM10 Yellow (edge of the angle).
With the edge of the angle of the 0.20 mm diameter EM10 Yellow electromaniple, the operator brushes the skin in small circular movements.
The current detaches the epidermis, which is not removed until the electrode has been brushed over the whole area encompassed within the preoperative design. The epidermis is removed with the same electrode, while not activated.
Once the epidermis has been removed, the pigmented dermis can be seen and the xanthelasma becomes more visible. Any fragments of epidermis that remain attached must be brushed again with the activated electrode. There must be no direct contact between the activated electrode and the dermis. Timedsurgical de-epithelialization maintains the integrity of the dermal papillae and the capillary-papillary plexus. This perfect integrity enables the resorcin to be absorbed uniformly.
The resorcin is applied with a cotton-wool bud for about 30 seconds, until a uniform frost is formed; it is then washed off with physiological solution. Mixed peeling is over. The xanthelasma is now vaporized. The Timed apparatus is reprogrammed with the following program data: Direct Pulsed 0.5/24.5 hundredths of a second, Coag, 50 Watts, EM10 Black electromaniple.
The micro-vaporizations precisely destroy the xanthelasma. The resorcin reduces the number of melanocytes and, owing to its potent cross-linking effect, reorganizes the dermal fibers. As a result of the coagulating effect of the solution, a thin crust forms within a few hours. This protects the area against infection and must be allowed to drop off spontaneously. No products need to be applied to the treated area. If there is any exudation, it should simply be dried with a paper tissue.
Pulsed timedsurgical de-epithelialization of the contralateral pigmented area is now performed.
The 50% resorcin solution is applied; after about 30 seconds, it is carefully washed off. The uniform frost is seen. This eyelid also presents a xanthelasma, which is micro-vaporized.
The long-term result of mixed peeling and de-epithelialization of the eyelids is that pigmentation disappears, any vascular ectasias are eliminated, and the roughness of the skin is reduced. This technique is also used to eliminate festoons and wrinkles from the lower eyelids and to reduce "crows' feet".
Capurro S. (2019): Eliminating dark eye-rings with timedsurgical mixed peeling. Timedsurgery section. https://www.crpub.org
By reducing the number of melanocytes, can timedsurgical mixed peeling with resorcin eliminate dark circles definitively?
Yes, this treatment is highly efficacious and very safe. Moreover, the results are permanent. Mixed peeling corrects hyperpigmentation and rejuvenates the lower eyelids. Removing the epidermis enables the resorcin to act on all the geometric points of the treated surface, without any risk. Let's remember that resorcin in an aqueous solution does not have any effect on intact skin.
What other indications for mixed peeling are there in this region?
There are two types of mixed peeling. In the upper eyelid, we use mixed peeling 0.5 with permeabilization of the epidermis. This technique is used to perform nonsurgical upper blepharoplasty; mixed peeling with de-epithelialization, by contrast, is used on the lower eyelid in patients with pigmented or wrinkled skin, palpebral festoons that are difficult to correct surgically, and evident crows' feet. This latter problem can also be treated with intradermal cellular Adipofilling. Mixed peeling to rejuvenate the skin of the lower eyelid is preferably performed in patients with a uniform complexion. If the complexion is not uniform, mixed peeling 0.5 with permeabilization is carried out. This type of peeling is less efficacious but leaves the complexion identical to that of the surrounding area.
We know that cellular Adipofilling can be injected under the fine palpebral skin to restore the correct volume of this region. When is it performed?
The Adipofilling suspension of living adipose and stromal cells can be injected into the dermis, in which case it has no volumetric effect, but exerts a potent regenerative action. Alternatively, it can be injected immediately beneath the skin, in which case it has a delicate volumetric effect. In the palpebral region, it corrects sunken eye-rings and distances the skin from the orbicular muscle, making the palpebral skin look brighter. After eliminating palpebral roughness by means of mixed peeling, we advise patients to undergo subcutaneous cellular Adipofilling in order to complete the rejuvenation of the region. In the treatment of the periocular region, in addition to surgical, transconjunctival and upper blepharoplasty procedures, and to mixed peeling with de-epithelialization and epidermal permeabilization, Adipofilling also has an important role to play.
Another procedure, which we are now refining for the treatment of this region, is canthopexy by means of the elastic thread. This restores the youthful elongated look of the eyes in a few minutes, without intervening directly on the canthus.
Are the program data of the Timed apparatus suitable for all patients?
Of course. These program data are based on real values and are used to perform over 70 standardized applications. The programmable Timed apparatus has been specially designed for the innovative procedures of Timedsurgery (Technique for the Implementation of Measured Electrosurgery Data). The high-frequency current used travels over surfaces at the speed of light. By contrast, light travels in a straight line. This is the main disadvantage of using laser beams in dermatology.