01. Permanent removal of wrinkles around the upper lip with timed-surgical mixed peeling
KEYWORDS: lip wrinkles, timedsurgical mixed peeling, Timedsurgery, de-epithelialisation, resorcinol.
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 lasting years.
Following a local anaesthetic, the skin of the lip is de-epithelialised using a specific timedsurgical programme, created for repigmentation of stable vitiligo. The programme data for this procedure are: Direct pulsed 4/9 hundredths of a second, Coag, 2 Watts or 3 Watts, EM 10 Yellow (bent at an angle).
This timedsurgical de-epithelialisation allows removal of the epidermis while maintaining the integrity of the dermal papilla 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-epithelialised is moistened with isotonic saline. The corner of the electromaniple is rubbed along the lip in small circular movements.
The specific current lifts the epidermis. Timedsurgical de-epithelialisation is performed on the entire upper lip surface, from just below the nose to 1 mm inside the vermilion.
De-epithelialisation is extended 5 mm on either side of the nasal-labial fold.
The electrode is cleaned frequently during de-epithelialisation.
Ablation of the epidermis is performed using 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.
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.
At the end of the de-epithelialisation 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. Application of the resorcin solution to the de-epithelialised area took a minute and a half in this patient, starting with the deeper wrinkles. The resorcin solution was then applied through the filter, after which it was applied to smaller wrinkles near the vermilion.
Both triangles on either side of the nose, where there are no wrinkles, are the last areas to be treated.
Resorcin creates an immediate and uniform frost.
The saturated solution, which is harmless to intact skin, is extremely effective on the de-epithelialised skin, where it acts on all the geometric points of the lip surface.
The resorcin is washed off using isotonic saline.
The solution is then re-applied to deeper wrinkles. After the mixed peeling, the patient need simply dry off the area with a tissue every few hours, with no need for any other medication.
After a few hours, a crust begins to form, which lasts for between 7 and 15 days. This crust will fall off itself and slight ensuing redness of the skin will appear, lasting for a short period.
The results of this standardized timedsurgical procedure cannot be obtained using any other technique. The wrinkles disappear, the skin rejuvenates, the swelling of the lip goes down and the results are lasting over time.
Top: pulsed timedsurgical de-epithelialisation. Middle: application of the saturated solution of resorcin and formation of the crust. Bottom: before and after. The shortening of the white portion of the lip indicates that the result is permanent.
Capurro S. 1998 Permanent removal of wrinkles around the upper lip with timed-surgical mixed peeling. CRPUB Medical Video Journal. Timedsurgery section. http://www.crpub.org
Why is it called mixed peeling?
Because it is a combination of a physical technique (pulsed timedsurgical de-epithelialisation) and a chemical technique (peeling).
Are the results of mixed peeling excellent in all patients?
Yes. However, it is important to avoid patients who are great sun-lovers, those with dark skin, those who are depressed, etc.
Can hyperpigmentation occur?
No. Rather, there may be slight hypopigmentation, which disappears with time and exposure to the sun. However, the upper lip is always a little tinged and slightly darker than the surrounding skin.
What advantages does timedsurgical mixed peeling have over other techniques?
The result is marvellous; wrinkles disappear, the texture of the skin is rejuvenated, the white portion of the lip is shortened, and the result is lifelong. This pulsed de-epithelialisation procedure is simple and practically risk-free.
Is anti-herpes prevention required?
No. Anti-herpes prevention is only prescribed in patients with a predisposition.
Isn't any medication necessary?
The patient should dry the area frequently with a paper tissue. The crust must be thin. When the crust drops off, the patient must not apply creams for 48 hours, in order to allow epidermal keratinisation, and then apply an emollient cream.
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