03. Ablation of medium and large sized facial keratosis with rapid pulsed timedsurgical undermining
KEYWORDS: keratosis, Timedsurgery®, Timed®, rapid pulsed timedsurgical cut
Medium- and large-sized facial keratoses are ablated by means of rapid pulsed timedsurgical cutting. Once the local anaesthetic has been given the Timed apparatus is programmed: Direct pulsed 0.3/5.3 hundreds of seconds, Coag, 27 or 38 Watts, EM 10 White. The tip of the electro-manipulator passes over and back across the keratosis detaching it from the underlying tissue.The electrodes must be tangential to the skin surface. The sharp edged area of the electrode is circumscribed to the last millimetres of the tip. The central part of these large keratoses is normally more compact and requires more electrodes passed over it. Later vaporizations are optional and are always carried out using the resurfacing function as this does not burn the tissue. Micro-vaporizations of resurfacing are carried out for haematostatic purposes or to vaporize irregular areas. The operator must keep in mind that simply exposing the keratosis to air contributes to its complete removal, so therefore it is important that no aggressive surgery is carried out on the residual tissue. Collagenase medication is applied. Results are permanent and long lasting.
Before and after treatment
Capurro S. (2001) Ablation of medium and large sized facial keratosis with rapid pulsed timedsurgical undermining. CRPUB Medical Video Journal. Timedsurgery section. http://www.crpub.org
Are keratoses on the body treated differently?
Keratosis on the body require much greater delicacy; timedsurgical resurfacing or timed emissions at 50 Watt for 1, 2 or 3 hundredths of a second are used.
Which of these two options is preferable?
We are evalu with Resorcin is dabbed on.) Another option is to apply 50 Watt for 1 or 2 hundredths of a second. Alternatively, a more delicate approach can be adopted; this involves using the resurfacing function and setting the time to 6 or 12 hundredths of a second. In the first case, an emission of 1/3 of one-hundredth + an emission of 1/3 of one-hundredth of a second is obtained; in the second case, the emission time is one-hundredth of a second (1/3 of one-hundredth + 1/3 of one-hundredth +1/3 of one-hundredth = 1 second).ating the second one, which has the advantage of being very well tolerated without anaesthesia and does not leave any residual areas of hypopigmentation.
What about small facial keratoses?
At present, we use resurfacing in the Coag function at 27 or 38 Watt with the EM15 electromaniple; this is the same treatment that we use for small senile lentigines of the face. (These latter lesions can also be treated by means of Electroporo-cosmesis, after which 25% trichloroacetic acid, saturated.
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