21. Permanent removal of upper lip wrinkles and treatment of a residual wrinkle with timedsurgical mixed peeling (de-epithelialisation and application of resorcin)
KEYWORDS: lip wrinkles, timedsurgical mixed peeling, Timedsurgery, de-epithelialisation, resorcin, Adipofilling
Timedsurgical mixed peeling is the technique of choice for the permanent removal of deep wrinkles of the lip.
Just one treatment is required for excellent results that last years.
Following local anesthesia, the skin of the lip is de-epithelialized by means of a specific timedsurgical program, created for the repigmentation of stable vitiligo. The program data for this procedure are: Direct pulsed 4/9 hundredths of a second; Coag, 2 or 3 Watts; EM 10 Yellow electromaniple (bent at an angle). Before the procedure, a saturated solution of resorcin is prepared.
A small quantity of resorcin powder is poured into a cup. The powder is then dissolved in a small quantity of isotonic saline or distilled water.
This timedsurgical de-epithelialization enables the epidermis to be removed while maintaining the integrity of the dermal papillae and the papillary-capillary plexus.
The tip of the EM 10 Yellow electromaniple is appropriately bent. The corner of the electromaniple is used.
The area to be de-epithelialized is moistened with isotonic saline. The corner of the electromaniple is rubbed over the lip in small circular movements.
The specific current lifts the epidermis. Timedsurgical de-epithelialization is performed on the entire surface of the upper lip, from just below the nose to 1 mm inside the vermilion border.
De-epithelialization extends 5 mm on either side of the nasolabial fold.
The electrode is cleaned frequently during de-epithelialization.
Ablation of the epidermis is performed with a non-active electromaniple.
There is no bleeding. The layer is avascular, since it is above the papillary-capillary plexus.
The thin layer of epidermis is removed.
The same EM10 electromaniple, while not activated, is used to remove the epidermis that has been detached by the pulsed timedsurgical current. Detachment begins from the nasolabial fold. The epidermis must detach because of the effect of the current, not because of the mechanical action of the electrode. If the epidermis does not detach, the operator touches it again, without making contact with the dermis, which must remain perfectly intact in order to absorb the chemical substance that will subsequently be applied. Obviously, de-epithelialization can only be carried out with a specific current. Energy from light sources travels in a straight line and is not able to detach the epidermis while maintaining the integrity of the dermis.
Timedsurgical de-epithelialization, timedsurgical permeablization of the epidermis and Electroporo Cosmesis are the three mixed peeling techniques that have revolutionized esthetic dermatological peeling. This mixed physical and chemical peeling enables us to use a chemical substance, resorcin, that has no effect on intact skin, but acts efficaciously on skin that has been permeabilized or de-epithelialized. These techniques avoid the risks associated with aggressive peeling procedures and, even in subjects with a nonuniform complexion, we can now eliminate blemishes from the skin without leaving such visible signs as achromic patches or modifications of the texture of the skin.
By the end of the de-epithelialization process, the resorcin powder has almost completely dissolved. A few granules are still visible at the bottom of the cup. The saturated solution is ready. In this patient, application of the resorcin solution to the de-epithelialized area took a minute and a half. The resorcin solution was first applied over the philtrum, and then to the wrinkles.
Both triangles on either side of the nose, where there are no wrinkles, are the last areas to be treated.
The resorcin immediately creates a uniform frost.
The saturated solution, which is harmless to intact skin, is extremely effective on de-epithelialized skin, where it acts on all the geometric points of the lip surface.
The resorcin is washed off with isotonic saline.
If there are any small areas where the resorcin has not created a frost, this means that the skin has not been de-epithelialized. In this case, the operator must de-epithelialize these small areas and reapply the saturated solution of resorcin. The solution will be applied again to the deepest wrinkles, if present.
After the mixed peeling procedure, the patient simply needs to dry off the area with a tissue every few hours; no other medication is needed.
After a few hours, a crust begins to form, which remains in place for 7 to 15 days. This crust will fall off by itself, leaving slight redness of the skin, which will last for a short period.
In rare cases, as in this patient, a thin wrinkle may remain. This can be re-treated with timedsurgical mixed peeling or with intradermal Adipofilling. This regenerative Adipofilling uses a suspension of living adipose and stromal cells prepared by means of the Adipopimer, an economical, disposable device designed by us.
As the patient does not need any volume enhancement or regenerative skin treatment in other areas, we proceed directly to mixed peeling under local anesthesia. De-epithelialization is carried out on a rectangle of skin that includes the wrinkle. This rectangle must be large enough to enable the connective fibers to reorganize and the wrinkle to disappear. After de-epithelialization, which is performed by means of the specific pulsed current at 1 Watt, the saturated solution of resorcin is applied. When the crust drops off, the treated area appears slightly depressed. In a few weeks, however, the dermis reorganizes and returns completely to health.
The results of this standardized timedsurgical procedure cannot be obtained by using any other technique. The wrinkles disappear, the skin is rejuvenated, the height of the lip decreases and the results are permanent.
Capurro S. (2021): Permanent removal of upper lip wrinkles and treatment of a residual wrinkle with timedsurgical mixed peeling (de-epithelialisation and application of resorcin). Timedsurgery section. https://www.crpub.org
Are the results of mixed peeling excellent in all patients?
Yes. However, it should be avoided in patients who are sun-lovers, those with dark skin, depressed subjects, etc...
Can hyperpigmentation occur?
No. Rather, slight hypopigmentation may ensue, but this will resolve over time and with exposure to sunlight. The upper lip is always a little darker than the surrounding skin.
What advantages does timedsurgical mixed peeling have over other techniques?
The result is marvelous: wrinkles disappear, the texture of the skin is rejuvenated, the white portion of the upper lip shortens and the effect is lifelong. In addition, the pulsed de-epithelialization procedure is simple and risk-free.
What can you say about Adipofilling?
Adipofilling is a revolutionary technique which has great possibilities in esthetic surgery. Not only does it have a splendid volumetric effect, it also exerts a potent regenerative action if the cell suspension is injected intradermally. Moreover, the fact that different Adipofilling suspensions can be conserved for use as a filler in subsequent months is extraordinary. Naturally, we only use this technique to treat wrinkles that are less deep.
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