Mesotherapy in Dermatology

MESOTHERAPY in DERMATOLOGY

Dr. Amr Ismail MDConsultant DermatologistMember of American Academy of Aesthetic Medicine

email:ahmismai@gmail.com

Definition

A minimally invasive aesthetic procedure employs multiple microinjections of pharmaceutical medications , amino acids , vitamins and others into the mesoderm.

Introduction

Mesotherapy was 1st described by a French Physician Michael Pistor 1952.In 1987, French Academy of Medicine recognized Mesotherapy as part of traditional medicine.

Skin Structure

Embryonic origin Adult Derivative

Ectoderm Skin EpidermisBrainBreastSweat glands

Mesoderm Fibrous tissue (connective)CartilageBoneMuscleFat

Endoderm GutLiverLungPancreas

Skin Structure

Dermis

Connective tissue is often used to describe the extracellular matrix plus the cells found in it, such as fibroblasts, macrophages, and mast cells.

ECM Structure

3 major fiber-forming proteins:Collagen, elastin, and fibronectinGAG : Hyaluronic acid one of 7.Proteoglycans.

Mesotherapy

Connective Tissue Shock Therapy

Indications

Hair: Telogen effluviumAndrogenetic AlopeciaFace :Facial rejuvenation (wrinkles + Firming)Facial pigmentation e.g. melasma.

Indications

BodyLocalised fat areas .Cellulite.Stretch marks.

How To Start

1. Materials & protocols / indication.2. Injection sites.3. Injection Depths.4. Needle size.5. Machine.

Materials

Classified into :Principals(Major)Complementary(Minor)

TIP:Mixture should contain 2-3 principals to achieve satisfactory results(>90%).

Hair

TelogenEffluviumHair Growth Stimulants

Principals Complementary

Biotin (Vitamin H/B7)Pantothenicacid (Vitamin B5)

Pyridoxine(Vitamin B6) Zinc + AzelaicacidMV + MTE

Hair

AGAHair Growth Stimulants5-ARI

Principals Complementary

MinoxidilFinasterideDutasteride

Zinc + Azelaicacid

MesoHair Protocols

Telogen Effluvium Androgenetic Alopecia

Biotin (P)Dexenol(P)MV + MTE (C)

Minoxidil(P) / Dutasteride(P) +Biotin(P)Dexenol(P)Zinc + Azelaic (C)

MesoHairInjection sites & depths 1-2mm

Face MesoLift / MesoGlow

Rejuvenation (Major)Proven to Stimulate collagen synthesis

Hyaluronic acidAmino acidsVitamin COrganic SiliciumFibronectin + Vegetal proteins (Collagen & Elastin)Vitamin A

Face MesoLift / MesoGlow

Rejuvenation (Complementary)Glycolic acidTaurineXADNMV & MTE

Major Firming

DMAE :1. Potent firming acts quickly and lasts

long.2. Acts in the neuromuscular union, as a

precursor of acetylcholine, the neurotransmitter responsible for muscular contraction, increasing the overall tone of the skin.DMAE + Organic Silicium

MesoGlow Protocols

GlowHA (P)

Silorg (P)

Purascorbol / Vitamin C (P)

Xadenal (C)

Lift (Firming)HA (P)

Silorgamine = Silorg + DMAE (P)

Puretinol / Vitamin A (P)

Taurinox (C)

MesoGlow/Lift Injection sites & depths 1-2mm

Face Pigmentation

MesoLighten▼ Melanogenesis

Principals Complementary

GlutathioneKojicVitamin CAzelaic acid

Glycolic acidTretinoin

MesoLighten Protocols

Kojic acid (P)Azelaic acid (P) Vitamin C (P)Tretinoin (C)

Glutathione (P)Kojic acid (P)Vitamin C (P)Glycolic acid (C)

MesoLightenInjection sites & depths 1-2mm

MesoLightenInjection sites & depths 1-2mm

MesoLightenInjection sites & depths 1-2mm

MesoLighten

Body

Localized FatCelluliteStretch marks

Localized Fat

LipoDissolve = Injection Lipolysis

Localized Fat IAAL

Injection Lipolysis Mesotherapy

Deep 12mmPPC + DOC (PCDC)Hyaluronidase-Collagenase-

ArtichokeIntermediate 6mm(L-Carnitine-Aminophylline-Yohimbine- Artichoke)

2 - 4 mmL-Carnitine

AminophyllinePentoxifylline

Effective complement

Phosphatidyl Choline (PPC)

An antioxidant derived from soy lecithin.PPC penetrates the adipocyte , breaks down fat . Dissolved fat is carried through bloodstream and excreted by kidneys and bowel.(P)LipoDissolve + proper diet + Exercise.

Localized Fat/ Injection Lipolysis

Lipolytic Enhancers:Deoxycholate: Bile salt(P).L-Carnitine: Enhances both lipolysis and fatty acid oxidation(P)Artichoke: Direct lipolytic (P)Aminophylline , Caffeine & Xanthine(P)Hyaluronidase & Collagenase: PPC enhancer Enzymes (C)

PPC + DOC

Detergent Effects of Sodium Deoxycholate Are a Major Feature of an Injectable Phosphatidylcholine Formulation Used for Localized Fat Dissolution.Rotunda AM, Suzuki H, Moy RL, Kolodney MS. Dermatol Surg 2004;30:1001-8.Division of Dermatology, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA.

Conclusions:

The phosphatidylcholine formula popularly used in subcutaneous injections for fat dissolution works primarily as a detergent causing nonspecific lysis of cell membranes. Our findings suggest that sodium deoxycholate is the major active component responsible for cell lysis.Thus,eliminating unwanted adipose tissue.

Localized Fat/ Injection Lipolysis

Circulatory Enhancers:Yohimbine:Alpha2-adrenergic Blocker.Aminophylline &Pentoxiphylline: PDEI

Drainage Enhancers:Artichoke:Diuretic and stimulates lymphatic drainage

Localized Fat/ Injection LipolysisProtocols

Phosphatidylcholine(P)Deoxycholic Acid(P) Vitamin complexAlpha Lipoic AcidAmino Acids

Phosphatidylcholine(P)Deoxycholic Acid (P)TaurineOrganic silicium

Phosphatidylcholine(P)Deoxycholic Acid (P)L-CarnintineAminophyllinePantothenic Acid

LipoDissolveInjection sites & depths12mm

LipoDissolve

LipoDissolveInjection sites & depths12mm

Cellulite

Aesthetically cellulite is a problem consisting of the visual presentation of weakened and damaged fatty tissue and connective fibrous tissue in the form of bumps and dimples, commonly known as “orange skin”.

Cellulite

Cellulite

Cellulite

Treatment must act in two different ways:on the fat (Lipolytic effect) on circulation (Venotonic effect + Drainage)

Cellulite

Lipolytic: L- Carnitine + Caffeine .Venostatic: Rutin – Aminophylline –Pentoxiphylline.Drainage: Artichoke.

Cellulite Protocols

L- CarnitineAminophyllinePentoxiphyllineYohimbineDMAEProcaine

L- CarnitineAminophyllinePentoxiphyllineDMAEVitamin CProcaine

All are Principals

MesoCelluliteInjection sites & depths 2mm

MesoCellulite

Stretch Marks

The connective tissue, including collagen and elastin, becomes increasingly damaged until eventually causing the formation of stretch marks.

Stretch Marks

Collagen Elastin Stimulating/ Restoring agentsOrganic Silicium / SilorgCentella AsiaticaVegetal proteins + Fibronectin

Firming agentsDMAE + Vitamin CDMAE + Idebenone.

MesoStretch Marks Protocols

Silorgamine =Silorg + DMAE Centella Asiatica

FibronectinVegetal Proteins

Idebe =Idebenone + DMAE

Vitamin CDMAESilorg

All are Principals

MesoStretch MarksInjection sites

Needle size

30/32 G x 4 mm 30/32 G x 6 mm 30/32 G x 12.7 mm

MesoGuns

Injection Techniques

PAPULE: 1 to 2mm, with bevel upwardsNAPPAGE: 2 to 4mm, angle of 30° to 60°POINT BY POINT: deep injections, 4 to 12mm

Contraindications

Pregnancy, blood thinners, IDDM, cancer patients, AIDS patients, coronary artery heart disease or heart dysfunction, People with arrhythmias, history of blood clots or strokes, autoimmune diseases or organ transplant recipients and skin conditions including: herpes & psoriasis.

MESOPORATION

Mesotherapy ------ Non invasviveNo needles are required.

MESOPORATION

A new complex process utilizes the skin's water based "channels" to allow ionic drug solutions to penetrate into the skin, via controlled "electroporation - like" electrical pulses.

MESOPORATION

MESOPORATION

MESOPORATION

email:ahmismai@gmail.com