MESOTHERAPY

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

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

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

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

HISTORY

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

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

HISTORY (CONT.)

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

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

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

Mesotherapy is created.• 2002 creation of University Diploma in

Marseille, Bordeaux and Paris.

INDICATIONS

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

INDICATIONS (CONT.)B) Pain:1) Sport’s injuries.

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

C) Others:G.I.T. disorders,insomnia, tonsilitis … etc

CONTRAINDICATIONS

1) Pregnant Female.2) Nursing Female.3) D.M. ( O.k. if controlled –be sure )4) Heart Dis. (arrhythmias )5) Children.

INSTRUCTIONS AFTER TREATMENT FOR 24 HRS.

1. No Exercise.

2. No Massage.

3. No Hot Shower.

4. No Caffeine.

DRUGS USED

A) Lipolytic drugs:

1. PPC

2. Caffeine

3. Aminophylline

4. Yohimbine

5. L – Carnitine

6. Co enzyme A

B) Trophic drugs:1. Silicum = Conjunctyl2. Vit. C3. Multivitamins4. Artichoke5. Na pyruvate6. Hyaluronic acid

C) Vasodilator drugs:1. Calcitonin2. Fonzylane3. Torental4. DicynoneD) Local anaesthia Lidocaine

PHOSPHATYDILCHOLINE

• The best lipolytic drug is PPC without any effect on weight loss.

• Either injected pure (Brazil) or diluted with saline Or in combination e.g.; Lidocaine 2.5 ml

Saline 2.5 ml PPC 5 ml

Aminophylline 5ml• In France PPC is not allowed; so using local anesthetic +

Lipolytic drug + Trophic drug + vasodilator drug.

PHOSPHATYDILCHOLINE (CON.)

PTC is lecithin from soya beans ( have 2 unsaturated fatty acids = linoleic + alpha linoleic acid)

PTC is produced in the body but have saturated fatty acid ( Palmitic + oleic + streaic acid ) in cell membrane of:

Liver cells. Adipocytes. Lungs of embryo from 4th month. “with more palmitic acid”

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

PHOSPHATYDILCHOLINE (CON.)

PTC. To be injectable needs:

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

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

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

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

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

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

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

1% are transported to kidney.

TYPES OF INJECTIONS

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

mesolift PPP = point by point or papule technique for tonsillitis

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

CELLULITE It is lumpy, orange peel, or cottage cheese

appearance of skin by strangled fat cells.Fat cells are held in place by a mesh of collagen

fibers in the subcutaneous tissue.If fat cells bloated with water or fat, cellulite appears

i.e. “fat cells bulge out the mesh of collagen fibers”.

FACTORS CAUSING CELLULITE

1. Hereditary

2. Pregnancy

3. Drainage problem (sp. lymphatic ).

4. Obesity

Interstitial or extracellar matrix is composed of:

1. Fibroblasts (structural fibrous protein )

2. Glycosaminoglycans

3. Glycoprotein (adhesive ptn.)

4. Proteoglycans

Cellulite appears if interstitial matrix is affected by:

1. Decreased collagen function + production2. Decreased Elastin3. Decreased Flow of micro circulation ( due to

acidosis + increased free radicals 4. Increased capillary permeability leading to

increased free water and then lipedema

CELLULITE CLASSIFICATIONS

1. 1st degree = cellulite does not appear if skin is punched.

2. 2nd degree = cellulite only appear if skin is punched but not appear during standing or laying down.

3. 3rd degree = cellulite appear during standing and punching the skin but not on laying down.

4. 4th degree = in all condition.

TREATMENT OF CELLULITE

1. Decrease lipoedema by Procaine + Benzopirone.

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

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

4. Stimulate C.T. regeneration by Conjunctyl.

TREATMENT OF FLACIDITY OF ARMS AND INNER THIGH

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

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

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

by PPP or Nappage injections.

COMPLICATIONS You have to alert your patients to all side

effects:1 ) Vasovagal Syndrome: Vasovagal Syndrome due to many injections

(100-200)a- Before treatment ask pt.

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

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

COMPLICATIONS (CONT.)

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

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

COMPLICATIONS (CONT.)

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

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

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

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

4. swelling: may start immediately + persist 1 week or more.

COMPLICATIONS (CONT.)

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

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

Treatment: Antiemetic or H2 blocker (Zantac).

COMPLICATIONS (CONT.)

7. Palpitations:• Increased in Hypertensive pt.

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

a) aminophylline if its serum level >20 mg / ml.

b) Yohimbine (parasympathomimmetics).8. Allergy:

• Sp. with a) Hyaluronidase b) PPC.• Treat as any allergic reactions;

DR. TAREK EL TANBOULI