[17–19]. It is generally used to remove the epidermis and some layers of the dermis according to the irregularities needed to be treated. The author uses it only for the treatment of the horny layer.

In aesthetic pathologies characterized by skin irregularities and dystrophies, such as acne, wrinkles, stretch marks, and sagging of the skin, the treatment of transdermal introduction of substances is preceded by a surface microdermabrasion treatment performed by a system using corundum powder crystals (aluminum oxide in a sterile, disposable package) that produces removal of the corneous layer with simultaneous vascularization of the tissue by mechanical stimulation (light suction–light pressure–dermabrasion).

A particular ultrasonic probe can be used vibrating at 25,000 Hz (Bright – Skin by Eporex® Method) [20] to remove the superficial layer and to prepare the skin to the introduction of the substances containing elastin, collagen, and amino acids. The same protocol is used for the treatment of cellulite. The treatment is integrated into the protocol.

28.4.2.2Transdermal Introduction of Substances (Trans Peel)

The skin has an exchange function with the outside environment, which is also used as a means of pharmacological introduction [21–24]. Endermal diffusion is a passive phenomenon, in fact the skin behaves like a passive membrane. Penetration of the substances takes place in two stages characterized by:

ssDormancy stage, in which the dermal layer is charged, usually electrically

ss Flow stage, in which the flow becomes constant

Dermoelectroporation treatment is a method that enable absorption using an equipment that generate electric pulses allowing the opening of special “electric gates” promoting the passage of substances of adequate size. The apparatus used for medical and aesthetic purposes is Transderm Ionto® by Mattioli Engineering. Dermoelectroporation treatment is applied by a discharge given by an electric inductor charged at a controlled current value and then discharged with a typical kind of reversible exponential voltage wave [25–30].

The reason why the method works well only after dermabrasion of the horny layer is because the high voltage in the classical electroporation produces partly poration of the horny layer and partly poration of the

dermis (with the residual energy after having perforated the horny layer).

Dermoelectroporation eliminates the need of the high voltage because the horny layer is eliminated with the dermabrasion and so the voltage to go through the dermis is lower. It works like the high voltage electroporation, however, replacing the dangerous and hardly controllable effect of the high voltage on the horny layer with the safer dermabrasion. The lesser energy is used only in order to open watery channels in the dermis. As the intradermal or subcutaneous use of collagen, hyaluronic, or elastin is the natural trial of regeneration or production plotted here, while it is being known as the plotted regeneration, can be stimulated using the substances of base that constitute the precursors of such substances.

All of this has opened a new frontier in the antiaging protocols of regeneration and rejuvenation reducing the use of needles and bloodier methodologies. Immediately after microdermabrasion, active substances such as collagen, hyaluronic acid, amino acids, and elastin or their precursors are introduced by means of dermoelectroporation treatment.

28.4.3 Photodynamic Treatment

Photorejuvenation using Intensive Pulsed Light (IPL) is an evolution of the laser since it does not send forth a wavelength coherent light that strikes water or other elements with direct surgical action, but it uses a photon as a flash that strikes particular photodermoreceptors that are stimulated or altered. Suitable mainly to affect hemoglobin and dark colors, it has shown an ability to transfer energy to the tissues that directly stimulates the principal vital reactions of the extracellular matrix and the new production of physiological collagen [31–33].

IPLisusedattheendofthesessionofTransderm(crystals microdermabrasion and Dermoelectroporation) or Eporex™ System (Ultrasonic scrub and iontotransfer) where it guarantees the transfer of a quantity of such energy to favor the use of the introduced substances and the activation of the tissue reactions of the matrix. Energy’s quantity is produced in the form of heat that allows important microarteriolar vascularization that favors the oxygenation of skin that is found in a state of microcirculatory suffering, particularly in the people who smoke or use the estrogen-progestin pill or drugs.