29. Permanent elimination of lip wrinkles by means of mixed peeling while maintaining the integrity of a dermal nevus
KEYWORDS: lip wrinkles, barcode, pulsed de-epithelialization, timedsurgery, resorcin
Lip wrinkles can be eliminated easily and permanently by means of timedsurgical mixed peeling, which consists of pulsed timedsurgical de-epithelialization followed by the application of a saturated resorcin solution for one to two minutes. Timedsurgical mixed peeling is the method of choice for the elimination of even deep wrinkles on the lips. A single treatment is enough to obtain a permanent result. The operation is an outpatient procedure and is carried out under loco-regional anesthesia.
Once the Timed apparatus has been programmed to the pulsed de-epithelialization function, in the coagulation mode at a power of 2 Watts, the lip is moistened with saline solution. The procedure involves brushing the skin with the edge of the angle of a 0.20 mm diameter EM 10 Yellow electromaniple. The specific high-frequency current lifts the epidermis from the dermis, while maintaining the integrity of the dermal papillae and the papillary-capillary plexus. De-epithelialization begins 5 mm outside the nasolabial fold. Above, de-epithelialization stops at the base of the nostrils and the columella. Below, a few millimeters of the vermilion border is de-epithelialized.
We have now reached the vicinity of a dermal nevus, which the patient wishes to keep. De-epithelialization is performed all around the neoformation. The chemical phase of mixed peeling acts only on de-epithelialized skin; it has no effect on intact skin with an intact epidermis. This procedure is particularly useful in order to avoid acting on pigmented lesions, which we do not de-epithelialize.
The edge of the angle of the electrode brushes the epidermis in small circular movements.
While making these small movements, the operator repeatedly touches the skin with the edge of the angle of the EM 10 Yellow electromaniple. The point of contact must be extremely small, so as to concentrate the low energy (about 2 Watts in the specific pulsed function).
During these small circular movements, the electrode brushes the epidermis twice: once when it comes into contact and once when it comes out of contact.
If the skin is too dry, the operator can moisten it with saline solution. The region where mixed peeling with de-epithelialization is to be performed can be prepared by applying a cream containing urea for a few days; alternatively, the treatment can be preceded by the first phase of Electroporo Cosmesis which improves the conductivity of the skin by eliminating the most superficial horny layer.
The epidermis has been almost completely lifted.
We now remove the epidermis by using the same electrode, without activating it. Timedsurgical de-epithelialization occurs at the level of the dermal papillae above the papillary-capillary plexus. The saturated solution of resorcin is prepared before mixed peeling begins. A small amount of resorcin powder is placed in a container and dissolved in a small amount of water. To ensure that the solution is saturated, some undissolved granules of resorcin must remain on the bottom of the container.
Once de-epithelialization is complete, the saturated resorcin solution is applied. As the solution touches the dermis a frost is produced. The philtrum is treated first. The solution is applied to the most evident wrinkles. Subsequently, it is applied to the region closest to the vermilion border, and then to the entire surface of the lip where hairs are clearly visible. Finally, a cotton stick is quickly swiped over the two hairless areas at the sides of the nasal wings. One and a half minutes after the beginning of the application of resorcin, the area is washed with abundant saline solution.
Elimination of the epidermis exposes the dermal layer, allowing the resorcin solution to be used. If this solution is applied to intact skin, it has no effect; on the dermis, however, it acts on all the points of the surface, giving rise to stable reorganization of the connective fibers, reduction of the surface of the lip and the permanent disappearance of wrinkles. The vertical shortening of the lip indicates the anatomical stabilization of the result.
By maintaining the integrity of the dermis, timedsurgical de-epithelialization allows constant and uniform absorption of the resorcin solution. De-epithelialization has enabled mixed peeling to be standardized.
In the post-treatment period, the patient dries the area repeatedly with paper tissues. After a few hours, a thin crust appears, owing to the coagulative effect of the resorcin. No creams, lotions, ointments or other products should be applied. The crust remains for one to two weeks, according to the application time of the saturated resorcin solution. When the crust falls off, modest reddening will be visible. No creams must be applied for one day after the crust has completely fallen off, in order to allow keratinization of the keratinocytes. Subsequently, emollient creams, zinc oxide creams and products that promote healing are applied. The result of this standardized procedure is optimal. Wrinkles are eliminated and the skin is rejuvenated. Once the slight redness has passed, the patient must expose to the sun.
Capurro S. (2023): Permanent elimination of lip wrinkles by means of mixed peeling while maintaining the integrity of a dermal nevus. Timedsurgery section. https://www.crpub.org
Is the result of timedsurgical mixed peeling permanent?
Yes, mixed peeling of the lip will no longer have to be repeated. If a wrinkle remains visible, is it possible to de-epithelialize 5 mm of skin and apply the resorcin solution, but this rarely happens.
When can the patient expose the skin to the sun?
As soon as the redness disappears, the patient can expose the lip to the sun, to stimulate the melanocytes present in the hair follicles.
Can there be hyperpigmentation problems?
No, there can't.
Can there be problems of hypopigmentation?
If the procedure is performed correctly, no. The saturated solution must be applied for the pre-established times to the skin of the lip where the wrinkles are, exactly where the terminal hairs are most numerous.
Can timedsurgical mixed peeling be carried out on other regions of the face?
It can be used to treat the eyelids roughness and festoons and crows’ feet. In this case, the saturated solution of resorcin is diluted to 50% and application lasts only 20/40 seconds.
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