form has a duration of few days when inserted in the dermal layer and does not behave as a filler, but as substance of stimulation for the production of the physiological collagen, particularly if associated with precursors of collagen, elastin, or hyaluronic acid.

In the linked form, named “cross-linked,” it is hooked to benzyl alcohol and has a more complex form so that it is reabsorbed more slowly. According to the concentration and of the type of application it can last from 2 to 8 months.

As a rule, these products do not give true complications in comparison to the non-absorbable substances. The author believes that we must avoid the complications of non-absorbable substances. It is better to use solid prosthesis such as solid silicone or Gore-Tex.

“ Biolifting” is a treatment that has the tendency to restructure the skin and to increase the lost volume in the process of aging, this strategy use chemical substances in association to particular laser introduced into the tissues “Endo Light Lift” and a new revolutionary methodology to increase energy in the tissues “Biodermogenesi®.”

28.6.1 Method

In synergy with treatments of Bioresurfacing, a protocol of treatment can be performed that allows the stimulation of the tissues and increases the volume with new harmony of the contours of the face. In this sense of “tissue fullness” and of “good hydration” it will give a juvenile aspect to the face. Only using absorbable substances such as hyaluronic acid in different concentrations, increases the length of time it will last.

Different forms of revitalizing substances or fillers containing hyaluronic acid can be used. These products contain a low quantity of proteins that limit the production of free radicals, reduce inflammation, and therefore allow the increase of the length of time the product lasts. This method improves the quality of the skin, reduces the wrinkles, and improves the expression of the eyes harmonizing the external aspect [36].

28.6.1.1 Superficial Layer

Non-linked hyaluronic acid is introduced by mesotherapy (drop by drop), by lines in the dermoepidermal layer, or in superficial intradermal layer. Good results

can be obtained in the treatment of the neck, acne, and in superficial irregularities of the skin. Restylane Vital® (Q-Med® company) is normally used for this use.

28.6.1.2 Middle Layer

Linked hyaluronic acid is used in low concentration, introduced drop by drop in the middle dermal layer. Good results are obtained for the treatment of the middle wrinkles and in the cutaneous restructuring. Typical areas are nasogenial folds where we can use normally Restylane® (Q-Med® company) or Teosyal 27 or 30 (by Swiss company Teoxane®), that contain reticulated hyaluronic acid.

28.6.1.3 Deep Layer

Linked hyaluronic acid used in high concentration is introduced into the deep dermal layer or into a submuscular layer in the treatment of the zygomatic area (where it improves the contours). Particularly, in submuscular area, the author prefers hyaluronic acid Sub-Q (Q-Med® company) or pork collagen (Evolence™), in association with barbed threads too.

28.6.1.4 Threads of Support

Prolapse of the tissues (tissue ptosis) causes contortion of the morphological anatomy and of the functional anatomy of the microstructures with alteration of the metabolic functions of the extracellular matrix with consequent formation of local lipo-lymphedema. Morphological alterations of the microvessels cause deceleration and lymphatic stasis that alters of the systems of oxidative reduction and increases the free radicals with metabolic damage to the extracellular matrix that activates the process of oxidative stress with microedema, formation of lipo peroxidation, mitochondrial and metalloproteasis damage, alteration of the collagen, inflammatory and chronic evolution toward the pathological fibrosis. Reposition of the tissue provides new metabolism and a new life for the same tissues (Fig. 28.7).

When an initial yielding of the skin results in irregularities and cutaneous depressions, (not yet requiring lifting or mini-lifting), the application of surgical threads can be added. Surgical unidirectional barbed