dr. tarek el tanbouli mesotherapy. injection of small doses of medications in the mesoderm with very...

Dr. Tarek El TanbouliDr. Tarek El Tanbouli

MESOTHERAPYMESOTHERAPY


Injection of small doses of medications in the Injection of small doses of medications in the mesoderm with very good effect on treating mesoderm with very good effect on treating dermatological lesions (ectoderm) or even dermatological lesions (ectoderm) or even internal lesions as GIT (endermic).internal lesions as GIT (endermic).

This term is suggested by Dr.Michel Pistor This term is suggested by Dr.Michel Pistor (French doctor 1958).(French doctor 1958).

Meso.= Middle; since we are aiming at correct Meso.= Middle; since we are aiming at correct location.location.

OR = mean : Intermediary dosage between OR = mean : Intermediary dosage between Allopathic therapy and Homeopathic therapy. Allopathic therapy and Homeopathic therapy.


HistoryHistory

After many previous studies in Europe After many previous studies in Europe started 1793 (Belgium + France) for started 1793 (Belgium + France) for injecting local anesthetics and injecting local anesthetics and histamine to treat musculoskeletal, histamine to treat musculoskeletal, tendon and Trigeminal pain lesions.tendon and Trigeminal pain lesions.

In 1948 Dr. Michel Pistor started pain In 1948 Dr. Michel Pistor started pain treatment mainly with local infiltration treatment mainly with local infiltration of Procaine.of Procaine.


History (cont.)History (cont.)

In 1958, the name Mesotherapy is suggested for In 1958, the name Mesotherapy is suggested for the 1the 1stst time after discovering more injection sites time after discovering more injection sites to treat more medical problems.to treat more medical problems.

In 1964 Dr.Pistor founded the French In 1964 Dr.Pistor founded the French Mesotherapy Society.Mesotherapy Society.

In 1976 1In 1976 1stst International Mesotherapy Congress. International Mesotherapy Congress. and the 1and the 1stst Hospital outpatient service for Hospital outpatient service for

Mesotherapy is created.Mesotherapy is created. 2002 creation of University Diploma in 2002 creation of University Diploma in

Marseille, Bordeaux and Paris.Marseille, Bordeaux and Paris.


IndicationsIndications

AA) ) AestheticAesthetic::1)1) Lipolysis.Lipolysis.2)2) Cellulite.Cellulite.3)3) Hair loss.Hair loss.4)4) Scar.Scar.5)5) Anti ageing.Anti ageing.6)6) Meso-Buttox.Meso-Buttox.


Indications (cont.)Indications (cont.)

B) Pain:B) Pain:

1)1) Sport’s injuries.Sport’s injuries.

2)2) Chronic inflammatory disorders Chronic inflammatory disorders (Rheumatic, Sacroiliatis, Knee & Shoulder (Rheumatic, Sacroiliatis, Knee & Shoulder osteoarthritis, etc…)osteoarthritis, etc…)

C) Others:C) Others:

G.I.T. disorders,insomnia, tonsilitis … etcG.I.T. disorders,insomnia, tonsilitis … etc


ContraindicationsContraindications

1)1) Pregnant Female.Pregnant Female.

2)2) Nursing Female.Nursing Female.

3)3) D.M. ( O.k. if controlled –be sure )D.M. ( O.k. if controlled –be sure )

4)4) Heart Dis. (arrhythmias )Heart Dis. (arrhythmias )

5)5) Children.Children.


Instructions After Treatment Instructions After Treatment for 24 hrsfor 24 hrs..

1.1. No Exercise.No Exercise.

2.2. No Massage.No Massage.

3.3. No Hot Shower.No Hot Shower.

4.4. No Caffeine.No Caffeine.


Drugs UsedDrugs Used


A) Lipolytic drugsA) Lipolytic drugs::

1.1. PPCPPC

2.2. CaffeineCaffeine

3.3. AminophyllineAminophylline

4.4. YohimbineYohimbine

5.5. L – CarnitineL – Carnitine

6.6. Co enzyme ACo enzyme A


B) Trophic drugs:B) Trophic drugs:1.1. Silicum = ConjunctylSilicum = Conjunctyl2.2. Vit. CVit. C3.3. MultivitaminsMultivitamins4.4. ArtichokeArtichoke5.5. Na pyruvateNa pyruvate6.6. Hyaluronic acidHyaluronic acid


C) Vasodilator drugs:C) Vasodilator drugs:

1.1. CalcitoninCalcitonin

2.2. FonzylaneFonzylane

3.3. TorentalTorental

4.4. DicynoneDicynone

D) Local anaesthiaD) Local anaesthia

LidocaineLidocaine


PhosphatydilcholinePhosphatydilcholine The best lipolytic drug is PPC without any effect The best lipolytic drug is PPC without any effect

on weight loss.on weight loss. Either injected pure (Brazil) or diluted with salineEither injected pure (Brazil) or diluted with saline Or in combination e.g.; Lidocaine 2.5 mlOr in combination e.g.; Lidocaine 2.5 ml

Saline 2.5 ml Saline 2.5 ml PPCPPC 5 ml5 ml

Aminophylline 5mlAminophylline 5ml In France PPC is not allowed; so using local In France PPC is not allowed; so using local

anesthetic + Lipolytic drug + Trophic drug + anesthetic + Lipolytic drug + Trophic drug + vasodilator drug.vasodilator drug.


Phosphatydilcholine (con.)Phosphatydilcholine (con.) PTC is lecithin from soya beans ( have 2 unsaturated fatty PTC is lecithin from soya beans ( have 2 unsaturated fatty

acids = linoleic + alpha linoleic acid)acids = linoleic + alpha linoleic acid) PTC is produced in the body but have saturated fatty acidPTC is produced in the body but have saturated fatty acid

( Palmitic + oleic + streaic acid ) in cell membrane of:( Palmitic + oleic + streaic acid ) in cell membrane of: Liver cells.Liver cells. Adipocytes.Adipocytes. Lungs of embryo from 4Lungs of embryo from 4thth month. “with more palmitic acid” month. “with more palmitic acid”

preventing its sticking so allowing inflation + deflation of preventing its sticking so allowing inflation + deflation of lungslungs (stimulate lung surfactant) (stimulate lung surfactant)


Phosphatydilcholine (con.)Phosphatydilcholine (con.)

PTC. To be injectable needs:PTC. To be injectable needs:

1)1) A solvent which is deoxycholic a. ( gallic a.) A solvent which is deoxycholic a. ( gallic a.)

2)2) A preservative which is Benzyl alcohol ( now A preservative which is Benzyl alcohol ( now known as PPC).known as PPC).

PPC max. dose in lipolysis = 2500 mg / session PPC max. dose in lipolysis = 2500 mg / session (every 4 – 8 w )(every 4 – 8 w )

Each area needs 1 – 4 sessions to get the results. Each area needs 1 – 4 sessions to get the results. (72 % of pt. need 2 session only).(72 % of pt. need 2 session only).


PPC helps dissolving the double layer of PPC helps dissolving the double layer of adipocytes producing nano size fat particles.adipocytes producing nano size fat particles.

At the same time, helps enzymes of mitochondria At the same time, helps enzymes of mitochondria of adipocytes to break down the triglycerides into of adipocytes to break down the triglycerides into mono ( continue for 8 w ).mono ( continue for 8 w ).

99% of dissolved fat transported to liver where 99% of dissolved fat transported to liver where metabolized into CO2 + H2O.metabolized into CO2 + H2O.

1% are transported to kidney.1% are transported to kidney.


Types of injectionsTypes of injections

1.1. IED = Intra Epidermic (1 mm depth)IED = Intra Epidermic (1 mm depth)2.2. IDS = Intra dermal superficial (1-2 mm depth) IDS = Intra dermal superficial (1-2 mm depth) N = Nappage = multi-pricking technique for cellulite N = Nappage = multi-pricking technique for cellulite

+ mesolift+ mesolift PPP = point by point or papule technique for PPP = point by point or papule technique for

tonsillitis + insomniatonsillitis + insomnia3.3. IDP = Intradermal (4 mm depth)IDP = Intradermal (4 mm depth) for hair loss 3 mm by oblique injection. for hair loss 3 mm by oblique injection. 4.4. Mesoperfusion ( 5-6 mm depth)Mesoperfusion ( 5-6 mm depth)5.5. IHD = Intra hypodermic (6-13 mm depth)IHD = Intra hypodermic (6-13 mm depth) for lipolysis + iliolumbar lig. painfor lipolysis + iliolumbar lig. pain


CelluliteCellulite

It is lumpy, orange peel, or cottage cheese It is lumpy, orange peel, or cottage cheese appearance of skin by strangled fat cells.appearance of skin by strangled fat cells.

Fat cells are held in place by a mesh of collagen Fat cells are held in place by a mesh of collagen fibers in the subcutaneous tissue.fibers in the subcutaneous tissue.

If fat cells bloated with water or fat, cellulite appears If fat cells bloated with water or fat, cellulite appears i.e. “fat cells bulge out the mesh of collagen fibers”.i.e. “fat cells bulge out the mesh of collagen fibers”.


Factors Causing CelluliteFactors Causing Cellulite

1.1. HereditaryHereditary

2.2. PregnancyPregnancy

3.3. Drainage problem (sp. lymphatic ).Drainage problem (sp. lymphatic ).

4.4. ObesityObesity


Interstitial or extracellar matrix is Interstitial or extracellar matrix is composed of:composed of:

1.1. Fibroblasts (structural fibrous protein )Fibroblasts (structural fibrous protein )

2.2. GlycosaminoglycansGlycosaminoglycans

3.3. Glycoprotein (adhesive ptn.) Glycoprotein (adhesive ptn.)

4.4. ProteoglycansProteoglycans


Cellulite appears if interstitial matrix is affected Cellulite appears if interstitial matrix is affected by:by:

1.1. Decreased collagen function + productionDecreased collagen function + production2.2. Decreased ElastinDecreased Elastin3.3. Decreased Flow of micro circulation ( due to Decreased Flow of micro circulation ( due to

acidosis + increased free radicals acidosis + increased free radicals 4.4. Increased capillary permeability leading to Increased capillary permeability leading to

increased free water and then lipedemaincreased free water and then lipedema


Cellulite classificationsCellulite classifications

1.1. 11stst degree = cellulite does not appear if skin is degree = cellulite does not appear if skin is punched.punched.

2.2. 22ndnd degree = cellulite only appear if skin is degree = cellulite only appear if skin is punched but not appear during standing or punched but not appear during standing or laying down.laying down.

3.3. 33rdrd degree = cellulite appear during standing degree = cellulite appear during standing and punching the skin but not on laying down.and punching the skin but not on laying down.

4.4. 44thth degree = in all condition. degree = in all condition.


Treatment of celluliteTreatment of cellulite 1.1. Decrease lipoedema by Procaine + Decrease lipoedema by Procaine +

Benzopirone.Benzopirone.

2.2. Stimulate micro-circulation by Procaine + vit C Stimulate micro-circulation by Procaine + vit C + penthoxiphylin.+ penthoxiphylin.

3.3. Stimulate lipolysis by procaine + PPC ± Stimulate lipolysis by procaine + PPC ± theophylline ± caffeine ±carnitine ±yohimbin.theophylline ± caffeine ±carnitine ±yohimbin.

4.4. Stimulate C.T. regeneration by ConjunctylStimulate C.T. regeneration by Conjunctyl..


Treatment of Flacidity of Arms Treatment of Flacidity of Arms and Inner thighand Inner thigh

1.1. DMAE : Di methyl amino ethanal DMAE : Di methyl amino ethanal using 2 – 4 ml (25 mg / ml).using 2 – 4 ml (25 mg / ml).

2.2. Vit.C using 2 ml (222 mg / ml)Vit.C using 2 ml (222 mg / ml)

3.3. Procaine using 1 ml (2%)Procaine using 1 ml (2%) For one thigh or arm.For one thigh or arm. Need 20 treatments with 2 weeks apart by Need 20 treatments with 2 weeks apart by

PPP or Nappage injections.PPP or Nappage injections.


ComplicationsComplications You have to alert your patients to all side effects:You have to alert your patients to all side effects:1 ) Vasovagal Syndrome:1 ) Vasovagal Syndrome: Vasovagal Syndrome due to many injections (100-Vasovagal Syndrome due to many injections (100-

200)200)a- Before treatment ask pt.a- Before treatment ask pt.

If dizziness or nausea occur to stop injections If dizziness or nausea occur to stop injections and give O2 mask for 2-5 min at 4 - 8 L /min.and give O2 mask for 2-5 min at 4 - 8 L /min.

Ask pt. to stay after injection in the clinic to Ask pt. to stay after injection in the clinic to be sure no loss of consciousness.be sure no loss of consciousness.


Complications (cont.)Complications (cont.)

b - Before treatment eat sugary or b - Before treatment eat sugary or ptn. diet (more empty stomach ptn. diet (more empty stomach more attacks).more attacks).

c - Injection better while lying down more c - Injection better while lying down more than standing position which may be than standing position which may be lethal with loss of consciousness.lethal with loss of consciousness.



2.2. Pain:Pain: Dull or burning pain at area of injection which become Dull or burning pain at area of injection which become

warm + red, within 5 min, lasts from 10 min. To few warm + red, within 5 min, lasts from 10 min. To few days.days.

Not treated by NSAID’s but better with mild narcotics Not treated by NSAID’s but better with mild narcotics as Hydrocodone or weak opiods e.g. tramal or as Hydrocodone or weak opiods e.g. tramal or distalgesicdistalgesic. .

3.3. Nodules:Nodules: occurred with non expert doctors or increased occurred with non expert doctors or increased conc. of PPC.conc. of PPC.

4.4. swellingswelling:: may start immediately + persist 1 week or more. may start immediately + persist 1 week or more.



5.5. Bruising:Bruising: persist 1 – 2 weeks so pt. must plan persist 1 – 2 weeks so pt. must plan their treatment according to their schedule sp. their treatment according to their schedule sp. wedding, swimsuit & modeling photo shoots.wedding, swimsuit & modeling photo shoots.

6.6. Nausea – or + diarrhea:Nausea – or + diarrhea: due to cholinergic due to cholinergic reaction (sp. aminophylline 250 mg) reaction (sp. aminophylline 250 mg)

Treatment: Antiemetic or H2 blocker Treatment: Antiemetic or H2 blocker (Zantac).(Zantac).



7.7. Palpitations:Palpitations: Increased in Hypertensive pt.Increased in Hypertensive pt.

Give O2 mask + diazepam ( tranquilizer ). Give O2 mask + diazepam ( tranquilizer ). Occurs with:Occurs with:

a) aminophylline if its serum level >20 mg / ml.a) aminophylline if its serum level >20 mg / ml. b) Yohimbine (parasympathomimmetics).b) Yohimbine (parasympathomimmetics).

8.8. Allergy:Allergy: Sp. with a) Hyaluronidase b) PPC.Sp. with a) Hyaluronidase b) PPC. Treat as any allergic reactions;Treat as any allergic reactions;

dr. tarek el tanbouli mesotherapy. injection of small doses of medications in the mesoderm with very...

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