Precise Electron Flow

The latest instrument for dermatological surgery is the F.EL.C.

Developed to address the need to intervene on poor conductive tissue that typically present difficulties for, such as the radio-frequency scalpel with dehydrated tissues, and lasers with non-pigmented tissues.  The F.EL.C. uses only low-powered electrons to obtain the very same results as those of high-powered lasers and/or radio-frequency scalpels.  

The F.EL.C., utilizing electrons, generates a thermal increase in tissues with higher electric resistance.  Taking advantage of this “Joule Effect”, a temperature increase is created specifically in those areas that present an elevated reactance.

An example of the use of the F.EL.C. is represented by a seborrheic lesion in a particularly sensitive area, such as that of the armpit/underarm, with a patient that cannot or denies the use of an anesthetic.

The seborrheic lesion is a poor conductor and doesn’t lend itself well to be treated without anesthesia.

During the operation, we would observe a small column of smoke, produced from the combustion of the unhealthy tissue, and a complete absence of reddening on the surrounding tissues.

The low power utilized without involving the surrounding tissues is the reason for the absence of discoloration and “crater effect” during the post-operation period.

CUTANEOUS SPOTS

The large chapter of cutaneous and discoloration spots, best highlight to better appreciate soft surgery and the F.EL.C.

Before the treatment  Immediately following the treatment

This illustrates an aging spot on the hand of a patient.

Immediately after “coloring” the spot, we would utilize absorbent cotton soaked with disinfectant based on benzalkonium chloride to rapidly wipe away the carbon residue produced by the combustion of the pigmented tissues.

This cotton ball, soaked with disinfectant, should be rubbed over the area treated, with a certain amount of force, as if the operator where using an eraser to draw.

In some prone subjects, a reddening colorization on treated areas, may last for longer periods.  In some cases depigmentation may falter.

The efficiency of this type of operation can be appreciated in this photo.

In the lower photo we observe an obvious aging spot with a pigmented and discheratosica formation.  Treated with the F.EL.C., we observe in the top photo, the perfect healing after six months of solar exposure.

MICRO PEELING FOR SEPARATED POINTS

While removing various types of cutaneous neoformations, the idea came to treat small high zones resulting from aged skin, as if treating micro neoformations.

Appearance of the area immediately following the F.EL.C. burn.  After seven (7) days, the skin appears notably better.

At this point, all of the remaining areas have been treated, obtaining a noticeable hydrated and lifting effect.  Treating only the pointed, raised areas present on the crest of the mamellonature, greatly impacts the duration of the carbonized crusts.

A second decisively “soft” technique consists in applying hydrant gel on the area to treat, and utilizing the F.EL.C. on it’s maximum setting, proceed to burn only the furthest outer layer, to only later remove the excess gel with some absorbent cotton.  In this case, we will be certain to no cause any crusts or carbonized deposits.

Even in this matter we would produce a smoothening effect, without any type of risks.

In the case of small, dated expression wrinkles, dated “bar-code” wrinkles, and small linear post-traumatic scars, crest spots are applied with the F.EL.C. at a low intensity.

These said superficial corneocyte burns will need to be distanced at least a millimetre apart from one another, in a manner to avoid creating a single crust that could potentially fracture and create many mini-craters.  The effect will be immediate and extremely gratifying.  The pain endured by the patient is so minimal that it doesn’t even require the application of a topical anesthetic.

Employing the same technique it is possible to intervene on those expression wrinkles that, treated with other techniques, have not completely disappeared.

Naturally, these operations will be carried out once the operator has acquired a strong command in the use of the F.EL.C.

This patient was treated for the removal of the upper lip wrinkles, not have achieved results for the large central wrinkle and that on the left, was treated with the F.EL.C. with a peeling by point technique.

In the upper-right photo, immediately after the sitting, we can note that effects of a treatment with separated points.

Lo stesso caso al controllo dopo una settimana.

The same case during a follow-up visit one week later

ACNE IN AN ACTIVE PHASE AND SCARING SIDE-EFFECT

A different approach to the cure and theory on the genesis of the acne process, came to mind by observing, always in the same point of the face, the appearance of a “lone” pimple in some patients a few days prior to their menstrual cycle.

To confirm that this idea, that was beginning to take form, was correct, I asked all of these patients “carriers of these lone pimples”, if they would be willing to undergo a plastic F.EL.C. treatment on the pilosebaceo duct that was suspected to be the cause of the problem.  The results proved that my theory was correct.  In fact, during the following months, the same patients referred the complete disappearance of any acne manifestation, in the treated area, during the premenstrual period.

Both blocked and unblocked blackheads may be treated, performing an actual reconstruction of the pilosebaceo follicle, deformed from the acne process.  The deformed follicle in the external outlet, tends to easily obstruct itself for various reasons.  The consumption of particular foods, premenstrual water retention, the hydro-saline variation of perspiration and fat induced by mental and physical stress, the use of creams with an obstructive effect.  In the case of post-acneic scars, we must exclusively treat the boarders and crests of the skin between one depression and the next, without touching in any manner the bottom of the scars.  Particular attention must be taken to avoid inadvertently wounding the patients skin with the pointed tip.

In order to reach the best results, the F.EL.C must graze the tissue surface without making contact, emitting an electron flow able to literally burn-away the dehydrated tissues with the greatest electrical resistance (Joule effect).  Should the pointed tip come in contact with the healthy tissue, reducing the electrical resistance between the tip and the surface, there would be a lack of thermal increase therefore no burn.  This combustion is demonstrated by the fact that if we were to apply oxygen on the operated tissue, an elevated temperature would develop risking to involve the surrounding tissues in this thermal phenomenon.  If instead of oxygen, we were to apply carbon dioxide, we would notice the extinguishing of the combustion reaction of the F.EL.C.  To summarize, during a F.EL.C. surgical operation a combustion is applied on the treated tissues with combustible traits, while oxygen in the air acts as the combustible.  In the case of severe acne depressions, it is suggested to treat the margins and the excess areas in more frequent visits, to avoid scar discoloration phenomenon.  In no matter should the papillary layer of the derma, the scar discolorations and similar retractions get involved with those resulting from other types of treatments.

Appearance of the treated area in the case of depressed scars

This image enables us to appreciate the technique utilized for each point.  It’s worth noting that the single points do not touch each other to avoid potential crust fractures.

Dorsal acne scars

Numerous and particularly wide and deep.  Some have a diameter of nearly a centimetre.  Obtained results with three applications at a distance of seven days from one another.

Evident post-acneic scars in the temporal zone

Appearance of the area after a few visits and after the crusts have naturally fallen.  The two small hematic exudations refer to a micro-detachment of two points particularly receded.

Other post-acneic scars in the temporal zone and after three visits

At a distance of seven days

Patient during a follow-up visit six months later

A case similar to the previous, complicated by fairly deep scars.

Even in this case, all pharmaceuticals, cosmetics (creams and gels), and facial cleanings were suspended.

In the second photo:  appearance of the area immediately following the operation.  Note that the carbon deposits from recent burn, may easily be removed by delicately wiping the area with absorbent cotton soaked with disinfectant based on benzalkonium chloride.

The final photo illustrates the results one year later and after six months without treatments to maintain under control potential development of pustules of which, as we can see, have not redeveloped.

Same case with frontal view

XANTHELASMA

With minimal pain during the F.EL.C. surgical procedure, the patient does not flinch and the area has not been anesthetized.

Appearance of the treated region after a F.EL.C. procedure for bilateral xanthelasma.

From the photo we can appreciate the scarce involvement with the surrounding tissue, and the absence of swelling and redness, characteristic of post-procedure in the this area.  Another case where we can appreciate the results 30 days after the procedure.

In the following case, we can perfectly comprehend the substantial difference between a procedure for xanthelasma surgically performed with the F.EL.C. and other techniques.

In the photo below we can observe the circular area where an xanthelasma was removed six years earlier.

The skin in the this area appears perfectly healed while in the surrounding areas new unhealthy areas have developed, as has also the counter-lateral eye starting to develop an xanthelasma.  The photo above illustrate a control visit two weeks later.

Other cases

Medium-sized bilateral xanthelasma, the bottom photo is prior to the procedure and the photo above is the monthly follow-up visit.   We can appreciate the perfect epitelizzation from the case on the right

EYELID LIFTING

This type of procedure is in no way intended to replace blepharoplasty eyelid surgery, but rather painlessly increase or “freshen up” ones look, without the need of stitches or the use of anesthesia, by eliminating the excess skin from the upper eyelid that afflicts many people.

First we must test an area to see how the treated area would respond and observe how the patient follows the post-procedure rules during the following days.  Lift a fold of skin with a smooth, rounded tweezer to precisely delimit the tissue to eliminate.  Vaporize the excess skin reaching the limit of the tweezers, for a maximum length of 5 mm.  The use of anesthesia is not absolutely necessary.

Repeat the procedure on the same excess fold of tissue, but at a interval of 5mm, in order to avoid leaving a single crust.

Appearance of the eyelid immediately following the procedure

We must “burn” non-contiguous areas of the skin, in order that the untouched areas act as stitches.  There is no need of anaesthesia for the procedure.  The untouched tissue areas left during this phase, will be treated during the second visit, seven days later.

Patient suffering from a slight hypertrophy of the right upper eyelid

The right eyelid was used as a test area.  In the upper left photo, a slightly visible fold of the eyelid utilized for the assay.  In the upper right photo, immediately following the procedure, and in the lower right photo, we can see the fold of skin ready to be removed.

The lower left photo illustrates the healed area, seven days later.

Same patient: procedure to treat the right upper eyelid.

In the upper right photo, we see the eyelid after the first visit.

Note that between one burn mark and another we must leave a point of healthy tissue to avoid a single crust that may be easily fractured and to keep the exported tissue margins close, as if we were applying stitches.

In the lower left photo, seven days later and in the lower right photo the results after fourteen (14) days and after having “F.EL.C.ed” the points left from the previous procedure.

TATTOOS

The removal of tattoos deserves particular attention.  In  fact, it is always necessary to perform a test in a hidden area, to evaluate potential scarring and/or discoloration.

If the result appears acceptable and, it must be reminded, the patients knows how to medicate him/herself, avoiding the crust from falling off prematurely, only then should we proceed with the complete removal of the tattoo.  Performed the test, the patient will have to apply a paste of salt and water on the area treated.  This paste of sodium chloride should be applied for at least thirty minutes and afterwards the area should be disinfected with 2% benzalkonium chloride.  Above perfectly illustrates both the techniques of tattoo removal with the F.EL.C. and the personalities of some tattooed.

NEOFORMAZIONI

Large facial fibroids and nevi of Niescel, can be eliminated without relapse o discoloration.  With the F.EL.C. the lesion can be removed and eventually sent for analysis.  In these cases it’s suggested to work on a higher plane in order to be able to easily smoothen the area treated.  Immediately following the procedure, conducted the ring technique in order to avoid the use of an anesthetic, the tissue may be touch because the will not bleed.  In this way we may appreciate the smoothing of the tissues with it’s surrounding areas. Usually the patient will medicate with benzalkonium and avoid gauzes and band-aids.

At the control visit after 15 days, the area treated will appear pink were the crust, now fallen off, used to be.  The results will be perfect if the patient will have avoided removing the crust before its time.  At a year’s distance we can appreciate the type of ( epitelizzazione.) regeneration of the skin

The presence of two facial neoformations.  Immediately following the removal of the first neoformation, without having removed the carbon deposits on the area treated / “burned” with the F.EL.C.

At the control visit we can observe the area treated seven days earlier, now devoid of the crust, and the second neoformation just operated and cleansed of the carbon deposits from the burn.  We can notice that the surround tissues are not reddened, testimonial to the fact that no heat was released during the procedure.  At the control visit, one year later, we can observe the perfect healing and the development of another neoformation.

A pigmented neoformation on the nasal side of the eye socket

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One year following the procedure, conducted always without anesthesia and with the F.EL.C., leaving even in this case, in a difficult zone, a damaged skin free of discoloration.

FORMAZIONI CISTICHE

CYSTIC FORMATIONS

Relapse, discoloration and depressed or hypertrofic scars are the most common results that we happen to observe.

With  the F.EL.C., a large seborrheic lesion of the temple, in the vicinity of the temporal artery, can be treated successfully.

By means of a 8-10 MHz vascular doppler, we can monitor the passageways of the blood-vessels beneath the lesion in order to avoid them, and to exclude the presence of abnormal vessels.

Once carried out the technique of the circular anesthetic, eliminating all of the unhealthy tissue.  We continually observe the scarce reddening of the surrounding tissues.

In many cases, a slight reddening may be due to the absorbent cotton soaked with disinfectant based on benzalkonium, utilized to remove the carbon deposits formed from the combustion of the treated tissues.

At the follow-up visit six months later, the treated area appears perfect from a chromatic point of view and the skins surface doesn’t present neither “crater effects” nor scaring.

Furthermore, we can notice that even the hairs, absent on the lesion, reappears on the area treated by the F.EL.C.

CICATRICIAL KELOID

Keloids and hypertrofic scars can be treated provided that a test be performed in a precise area and verify that the patient is capable of self-medicating the area without applying band-aids and without removing the crust before its time.

A scar in the under-arm of a patient operated for cutaneous hypertorphy of the roots of the upper limbs.

The F.EL.C. is utilized to burn the excess edge portions with the scope of leveling the tissue without causing further discoloration.

Correction of excess scar tissue following an accident

Treating the area is rendered simple from the moment that the tissue to remove is identified by a low, grazing light. To avoid regrowth after the treatment, the keloid must never bleed and the surrounding tissue should never redden.

With the F.EL.C., we are able to eliminate the scar within 2-3 visits, always if the patient cooperates and avoids irritating the area treated.

Taking extreme attention to not harm the skin or the collagen formation, the operator will astutely near the point, firmly supporting the side of the hand and wrist on the surrounding area in order to nullify any eventual movements of the patient.

Evident facial scars may also be treated, intervening exclusively on the edges and on the raised keloids.  Many follow-up visits are necessary in order to avoid risking damage upon damage.