03. Ablation of medium and large sized facial keratosis with rapid pulsed timedsurgical undermining
Medium and large sized facial keratoses are ablated with a rapid timed-surgical dissection. 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.