19. Eliminating wrinkles from the lower eyelids with Timedsurgical mixed peeling
KEYWORDS: mixed peeling, lower eyelid wrinkles, transconjunctival blepharoplasty, Timed apparatus, resorcin, de-epithelization
Timedsurgical mixed peeling is the technique of choice for the permanent elimination of wrinkles and large folds from the lower eyelids.
The effects of skin aging in the palpebral region are difficult to correct by means of surgical techniques. However, if the overall appearance of the face is to be successfully rejuvenated, aging of the eyelid skin needs to be treated. Just think of a face that has been rejuvenated by means of elastic lifting, but which still has aged skin in the palpebral regions. Mixed peeling consists of pulsed timedsurgical de-epithelialization, followed by the application of a solution of resorcin. Mixed peeling is a safe technique and its efficacy is ensured.
The specific current generated by the Timed apparatus (Korpo – Italy) detaches the epidermis from the dermis while preserving the integrity of the dermal papillae and the capillary-papillary complex.
Once the epidermis has been removed, the dermis is seen to be intact. There is no bleeding, as we are working above the capillary plexus of the dermal papillae.
On completion of de-epithelialization, we apply a saturated solution of resorcin diluted to 50%. Resorcin has no effect on intact skin; it only acts on de-epithelialized skin.
After about 20 – 30 seconds, "frosting" will be seen. The resorcin is then removed by means of a gauze soaked in physiological solution.
After a few hours, a thin crust forms. The patient should frequently dry the treated areas with a paper tissue. Creams and other substances must not be applied. After 7 - 15 days, the crust drops off, leaving slightly reddened skin without wrinkles.
Capurro S. (2020): Eliminating wrinkles from the lower eyelids with Timedsurgical mixed peeling. Timedsurgery section. https://www.crpub.org
Eliminating wrinkles from the lower eyelid is important. What other methods can be used to achieve this goal?
The only standardized and consistently efficacious technique that can rejuvenate the skin by eliminating wrinkles is mixed peeling; no other technique can do this.
The result of mixed peeling can be further improved through volume enhancement, which is achieved by means of injecting adipose and stromal cells (Cellular Adipofilling).
What is the difference between mixed peeling of lip wrinkles and mixed peeling of the lower eyelid?
The de-epithelialization is the same. To eliminate lip wrinkles, a saturated solution of resorcin is applied to the de-epithelialized skin. To treat the eyelid, the resorcin solution is not saturated; it is diluted to 50%. The application times are also different: from 1 to 2 minutes on the lips, and about 20 - 30 seconds on the eyelids. The operator has to judge by the frosting effect.
Why is no type of medication used?
The resorcin solution exerts a coagulating effect. Within a few hours, a crust forms, which prevents infection. The patient must dry the area repeatedly during the first few hours, in order to keep the crust thin. Applying creams or other products to areas of resorcin mixed peeling is very risky and must be avoided.
What are the indications for this timedsurgical procedure?
Roughness of the lower eyelid, palpebral folds, crow’s feet and dark circles under the eyes. Mixed peeling can also be performed after transconjunctival blepharoplasty. This association is advantageous because it eliminates the roughness of the eyelids without changing the patient's look.
Does mixed peeling eliminate pigmentation?
The technique used to treat the lower eyelids also eliminates dermal pigmentation. The reduction in the number of melanocytes stabilizes the result.
Is de-epithelialization also carried out on the upper eyelids?
On the upper eyelids, we prefer to use 0.5 mixed peeling, which perfects surgical upper blepharoplasty and can, in many cases, replace it.
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