22. Mixed peeling of the lower eyelids after elastic canthopexy and upper blepharoplasty
KEYWORDS: mixed peeling, timedsurgical de-epithelialization, Timed, electromaniple, resorcin, eyelid wrinkles, crows' feet, palpebral festoons
This patient first underwent elastic canthopexy, followed subsequently by upper blepharoplasty. We will now eliminate the wrinkles from her lower eyelids by means of timedsurgical mixed peeling, a physical-chemical technique.
The areas where the wrinkles are visible are marked out. The preoperative design must include the crows' feet.
Local anesthesia is carried out by means of a 25 G cannula. On completion of local anesthesia, a saturated solution of resorcin is prepared. A little resorcin powder is placed in a small container and partially dissolved in a small amount of water.
The Timed apparatus is programmed with the specific data for pulsed timedsurgical de-epithelialization: Direct Pulsed 4/9 hundredths of a second, Coag, 2 Watt. An EM10 Yellow electromaniple is used, the electrode of which is bent at an angle.
The edge of the angle of the electromaniple brushes the surface of the skin inside the preoperative design in small circular movements.
The specific pulsed current of the Timed apparatus detaches the epidermis from the dermis. Brushing the surface concentrates the current at the point of contact. To ensure optimal conductivity, the operator repeatedly cleans the electrode on his glove. If the skin is dry, it can be moistened with physiological solution, in order to improve conductivity. The epidermis is detached in an area extending from immediately below the eyelashes to the line of the preoperative design. The epidermis is not removed yet.
Once the activated electrode has been brushed over the areas marked out, preparation of the resorcin solution is completed.
A syringe is used to aspirate 1 ml of physiological solution and 1 ml of saturated resorcin solution; in this way, a saturated solution diluted to 50% is created.
The epidermis is now removed from the dermis with the non-activated electromaniple. If any fragments of epidermis do not detach, they are again brushed with the edge of the angle of the activated EM 10 Yellow electromaniple. When activated, the electromaniple must never come into contact with the dermis. The perfect integrity of the dermis ensures that the resorcin will be uniformly absorbed.Once the epidermis has been completely removed, the chemical phase of the procedure begins. The resorcin solution is applied to the de-epithelialized skin.
On contact with the dermis, the resorcin causes immediate "frosting". As is well known, resorcin in an aqueous solution has no effect on intact skin. If, however, it is applied to the de-epithelialized areas, it acts efficaciously and uniformly.
After about 30-40 seconds, the resorcin is removed with physiological solution.
The treated areas are dried with a paper tissue. After a few hours, a crust forms; this must be left to drop off spontaneously. No chemical products must be applied to the treated area. When the crust has dropped off, the patient waits another day, to allow keratinization of the new epidermis. Subsequently, cosmetic products may be applied. A month later, slight reddening is still visible; this will disappear within a short time.
The result is that the wrinkles of the palpebral festoons have been permanently eliminated and the skin has been made firmer.
Capurro S. (2022): Mixed peeling of the lower eyelids after elastic canthopexy and upper blepharoplasty. Timedsurgery section. https://www.crpub.org
A lot of doctors don't use strong peeling techniques on the eyelids because they think they're risky. What do you think?
They are right. Peeling techniques that use strong acids risk penetrating through the epidermis. Our peeling technique, which combines physical and chemical methods, is extremely efficacious and safe. Instead of acids, we use a substance that produces no effect if applied to intact skin. In practice, our peeling procedures are both the safest and the most efficacious.
What other indications are there for timedsurgical mixed peeling with de-epithelialization?
One of the most frequent is hyperpigmentation of the lower eyelids (dark circles). This problem is solved in a single treatment session. Mixed peeling with de-epithelialization is the only technique in the world that can achieve this result.
Another common application is the elimination of wrinkles and festoons from the eyelids after transconjunctival blepharoplasty. If lower blepharoplasty is performed by means of a skin incision, it changes the shape of the eyes. For this reason, we abandoned this approach about 25 years ago. Instead, we use the Timed apparatus to remove all the adipose pouches through two 8 mm incisions in the conjunctiva. Other uses of mixed peeling with de-epithelialization are: the elimination of lip wrinkles; the elimination of large skin patches; the treatment of giant nevi of the scalp, which we treat within the first 10 days of life; depigmentation of the skin in patients with generalized vitiligo, etc...
Some surgeons say that adipose pouches of the lower eyelids should not be completely removed.
We disagree. These adipose pouches are where they should not be. The anatomical structure of the pouches has the property of retaining water; the pouches therefore swell if the patient eats salty food. It should also be borne in mind that the complete removal of adipose pouches creates a concave area, which distends the overlying skin. For this reason, it is rarely necessary to remove any skin (only in the case of asymmetry). Unfortunately, many surgeons continue to perform lower blepharoplasty by means of skin incision; this is because they lack the skill and/or the technology needed in order to perform this procedure through the conjunctiva. Transconjunctival blepharoplasty does not change the shape of the eye!
What other method can be used to rejuvenate the patient's look?
If necessary, we use cellular Adipofilling. The adipose and stromal cells in this suspension rejuvenate the upper eyelids; in the lower eyelids, they enhance the volume of the malar region and eliminate sunken eye-rings and the lacrimal sulcus. Elastic canthopexy is another recent minimally invasive procedure; it elongates the eyes and corrects the appearance of eyes that are too close together.
In addition, we advise thorough cleansing of the eyelashes, cleansing of the skin in the morning and evening, and the application of bionic serums to the face and eyelids; these serums act on the energy centers of the cells, perfecting and maintaining the results of our procedures.
What are these bionic serums?
They are serums (Korpocare) which combine the principles of advanced physics with cosmeceutics. We use Oro&Seta, Orizzonte, Contorno Occhi, Mito Gold C, Combi and R, to perfect and maintain our results.
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