The author prefers to use a wavelength around the 640–690 nm in association with a lower wavelength (530–580 nm) nm in most cases. Normally, in the patients with Fitzpatrick, 5–6 IPL is not used. The scheme for the use of IPL in Bioresurfacing is:

1.Endermologie treatment

2.Scrub peel

3.Intensive pulsed light

ss 640 nm × 23–27 J/cm2 ss 560 nm × 24–28 J/cm2

4.Sessions at 15, 21, and 30 days

When it is necessary, the result can be increased using a non-ablative diode laser 532 by a rotating scanner for stimulating new connective structure and new cellular metabolism [34, 35] (Fig. 28.6).

28.5T3-Bioresurfacing: Protocol of Treatment

The treatment is used for the cutaneous improvement of the skin irregularities and for the signs of aging by stimulating the production of new collagen and stimulating the extracellular matrix. Different sessions at 15, 21, and 30 days are performed.

1.Physiotherapeutic phase with lymphatic drainage, skin vascularization, and connective stimulation using Lift Massage Endermologie® LPG System.

2.Scrub-peel using superficial microdermabrasion with crystals of corundum to smooth the skin and to open the horny layer followed by introduction of precursor substances of collagen, elastin, and hyaluronic acid using dermoelectroporation connected to the instrument “Ultrapeel Transderm®” or “Eporex System®” that allows opening of the pores that are the watery channels.

3.Energy administration by Intensive Pulsed Light offered by an instrument Quantum® IPL with an energy of 532–695 nm, or rotating diode laser scanner 532 nm (by Italian laser Eufoton®) that allows stimulation of the cellular function and the extracellular matrix.

At the end, an antiherpetic cream or lenitive substances can be applied for therapy or cosmetic action.

Bioresurfacing allows the patient to use makeup about 20 min after the procedure. Particularly in winter, the

patient uses a nighttime cream based with phytic acid and vitamin C (Stand By 5% Vitamin C® cream), to alternate sometimes with a mix of retinoic acid (0.0025%) and lower part of cortisone cream in low dosage. Such protocol will not produce immediate visual effects from the surgery or from the use of fillers but it will favor a slow but continuous improvement of the aspect and the tropism of the skin with progressive rejuvenation of the face.

28.6 Biolifting

In patients without true cutaneous excess and tissue prolapse and where the aesthetic pathology is characterized by a reduction of the “structure” and of the “tropism” of the skin with reduction or regression of the adipose and the connective tissue, surgery is not always suitable and is not the first indicated treatment, even if it can be sometimes of help. These cases, as a rule, represent the large majority of the patients 25–40 years of age. These patients do not have an indication for the traditional surgery with traction and excision of the tissues. They are patients with “nasogenial wrinkles” that begin to become “nasogenial folds” and, especially in hyperactive subjects, where the crows’ feet and the peribuccal irregularities are in association with the true and deep wrinkles. As a rule, these patients are found in the central phase of their social evolution and working activity. They normally request lesser treatments and above all wish to improve without changing. The treatment of choice is dermosurgical, mini-invasive treatments, and the use of substances of fillers to increase the volume and to redraw the contours of the face.

The substances that the author prefers are the traditional “Fillers” that have the characteristic to be natural and to be reabsorbed in different periods of time, but always absorbable substances. These substances belong to two major groups: the family of collagen and that of hyaluronic acid. The collagen was initially derived from tendons of ox and horse that required testing for the dangers of allergies and complications. Today, such risks are reduced and we have a new pork collagen not requiring test and with good results on the time (Evolence®).

Hyaluronic acid can also be used. It has the principal characteristic to be natural (not from animal derivation), absorbable, and does not have complications. Nonlinked hyaluronic acid constitutes a substance of great use in ophthalmology and orthopedics. The non-linked