Q) When timedsurgical resurfacing is carried out in the coagulation mode, is there any risk of causing a greater than necessary destructive effect?
A) Timedsurgical resurfacing exerts a potent effect, but this effect is superficial. It does not heat the healthy underlying tissues, which would cause damage. Let us remember that resurfacing is also used for hemostasis during electroshaving, a procedure in which regeneration of the skin begins immediately after the removal of the neoformation, thanks to the absence of necrosis.

Q) Why are two sessions necessary?
A) As xanthelasma is due to a familial metabolic predisposition, we cannot guarantee that the lesion will disappear definitively. The operator must tell the patient that xanthelasma is due to a metabolic alteration and that its treatment will require two sessions.

Q) In timedsurgery, are there really over 70 techniques, each with its own program data?
A) Timedsurgery (Technique for the Implementation of Measured Electrosurgical Data) utilises the Timed TD 50 Micropulse apparatus, which is specifically designed to be programmable. This means that we can control all the parameters that condition the effect of a high-frequency current. The high-frequency current is not influenced by the colour of the skin, but by its electrical conductivity, which is very similar from one individual to another. Each of the more than 70 applications has its own precise program data and uses a specific electromaniple. Specially designed currents have been created in order to perform operations that were previously impossible, such as de-epithelialisation of the skin, rapid or slow timedsurgical cutting, resurfacing, etc.

Q) Is the result of timedsurgical mixed peeling permanent?
A) Yes, mixed peeling of the lip will not have to be repeated. If a wrinkle should remain visible, a 5 mm area of skin may be de-epithelialised and the resorcin solution reapplied. However, this is rarely necessary.

Q) When can the skin be exposed to the sun?
A) As soon as the reddening disappears, the lip can be exposed to the sun; this will actually stimulate the melanocytes present at the bottom of the hair follicles.

Q) Might there be problems of hyperpigmentation?
A) No, absolutely not.

Q) Might there be problems of hypopigmentation?
A) No, not if the procedure is carried out properly. The saturated solution must be applied for the set times to the skin of the lip where the wrinkles are present, exactly where the terminal hairs are most numerous.

Q) How does the resorcin solution act?
A) The saturated solution of resorcin in water is not efficacious on intact skin; it can only act on de-epithelialised skin. Elimination of the epidermis enables the resorcin to act uniformly on the whole area. During frosting, the saturated solution of resorcin has a toxic effect on the melanocytes. This reduction in the number of melanocytes makes resorcin an extremely interesting de-pigmenting agent.

Q) How is the patient medicated?
A) After washing the resorcin solution off, the operator applies a cortisol solution, for example a vial of Betamethasone. Over the next few hours, the patient repeatedly dries the area with a paper tissue until a thin crust forms; the crust will be left to drop off on its own. When the crust drops off, slight reddening will remain; this will disappear completely within a few months. During this period, the patient will apply a zinc oxide cream every morning and evening.

Q) How is the saturated solution of resorcin made?
A) A small amount of resorcin powder is dissolved in a few drops of water. When a few granules of resorcin remain on the bottom of the vessel, the solution is saturated.

Q) In this procedure, the achromic epidermidis is replaced by cultivated epidermis endowed with melanocytes. What is the advantage of this procedure?
A) Timedsurgical de-epithelialisation leaves the dermis intact. If the dermis is intact, the graft takes root 100%. After this procedure, the re-pigmented skin will have the appearance of the patient’s normal skin and no scarring or surgical artefacts will remain.

Q) Can this technique be used in all forms of vitiligo?
A) No, only in stable vitiligo and piebaldism.

Q) Can scars be re-pigmented, too?
A) Yes. We have successfully carried out this procedure on numerous large achromic scars.

Q) Do you use this technique to treat small achromic scars?
A) No, it is too costly. If the scars are small, we only apply Timed micro-evaporation at 50 Watts for 1/3 of a hundredth of a second. Once the achromic epidermidis at the edges and above the scar has been removed, the scar will be re-epithelialised from the adjacent epidermis of the healthy skin and normal pigmentation will be restored.

Q) What sort of achromic areas are treated with timedsurgical micro-evaporation?
A) We treat small iatrogenic achromic lesions and solar lesions in this way. Achromic surgical scars of the face and body also disappear from view after this treatment.

Q) For which other procedures can pulsed timedsurgical de-epithelialisation be used?
A) To eliminate deep lip wrinkles and crows’ feet; to de-pigment dermal-epidermal patches; to treat recurrent plane warts, and to treat epidermolysis bullosa. In this last procedure, the pathological epidermis is replaced by epidermis modified by genetic engineering.

Q) How is the antiseptic powder applied?
A) The powder is sprinkled on a wad of cotton-wool and applied like a face powder; the excess powder is then removed with the cotton-wool. The crust must remain thin.

Q) How do you generate the micro-arc?
A) The micro-arc is generated through the air. The tip of the electrode touches the tissue and is then withdrawn; this triggers a micro-arc, which ionises the air. The ionised air is conductive and maintains the micro-arcs when the electrode passes very close to the surface of the skin.

Q) How much time must elapse between one session and the next?
A) On the face, at least two months.

Q) Are keratoses on the body treated differently?
A) 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.

Q) Which of these two options is preferable?
A) We are evaluating the second one, which has the advantage of being very well tolerated without anaesthesia and does not leave any residual areas of hypopigmentation.

Q) What about small facial keratoses?
A) At present, we use resurfacing in the Coag function at 27 or 38 Watts 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 45% citric acid or 25% TCA saturated with resorcin is dabbed on. Another option is to apply 50 Watts for 1 or 2 hundredths of a second. Alternatively, a more delicate approach can be adopted; this involves using the resurfacing function at 50 Watts and setting the time to 1 or 6 hundredths of a second. In the first case, an emission of 1/3 of one-hundredth of a second is obtained; in the second case, the emission time is 2/3 of one-hundredth of a second.

Q) Why is it called mixed peeling?
A) Because it mixes a physical technique (pulsed timedsurgical de-epithelialisation) with a chemical technique (peeling).

Q) Are the results of mixed peeling excellent in all patients?
A) Yes. However, the procedure should not be carried out on patients who habitually expose their skin to the sun, those with dark skin, those who are depressed etc.

Q) Can hyperpigmentation occur?
A) No. Slight hypopigmentation is more likely; this disappears with time and exposure to the sun. The upper lip is always a little patchy and slightly darker than the surrounding skin.

Q) What advantages does timedsurgical mixed peeling have over other techniques?
A) 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 life-long. This pulsed de-epithelialisation procedure is simple and practically risk-free.

Q) Is anti-herpes prevention required?
A) No. Anti-herpes prevention is only carried out in predisposed patients.

Q) Is no medication needed?
A) The patient repeatedly dries the area 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; subsequently, an emollient cream is applied.

Korpo thanks the open-access Medical Video Journal CRPUB.ORG for the material provided.