Mesotherapy in dermatology 19 may 2010


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Mesotherapy in Dermatology , by Dr. Amr Ismail MD , Consultant Dermatologist.
Mesotherapy in Depth
Non-prescrition treatment modatlity.
Non Conventional Safe Asethetic Procedure.
Should rely on EBM.
To achieve good results.
Depend on Used Meostherapy Materials.
Classification of Meostherapy Materials

A. Principals :

Ingredients that have been used orally or topically or injectable
for treatment of each indication/condition.
Ingredients with high grade of evidence in treatment of each indication/condition.
Ingredients that have been FDA Approved for treatment of each indication/condition.

B. Complentary :

Ingredients that have been claimed to improve the condition.

Ideal Mesotherapy Materials / Cocktails :

To achieve good results 80- 90 % , your used cocktails should
contain 2 -3 principals.

Published in: Health & Medicine, Business

Mesotherapy in dermatology 19 may 2010

  1. 1. MESOTHERAPY IN DERMATOLOGY Dr. Amr Ismail MD Consultant Dermatologist Member of American Academy of Aesthetic Medicine 19 th May 2010 Facebook: Laser and Skin Care Center
  2. 2. Definition <ul><li>Mesotherapy employs multiple microinjections of pharmaceutical medications , amino acids , vitamins and others into the mesoderm. </li></ul>
  3. 3. Introduction <ul><li>Mesotherapy was 1 st described by a French Physician Michael Pistor 1952. </li></ul><ul><li>In 1987, French Academy of Medicine recognized Mesotherapy as part of traditional medicine. </li></ul>
  4. 4. Skin Structure
  5. 5. Skin Structure Embryonic origin Adult Derivative Ectoderm Skin Epidermis Brain Breast Sweat glands Mesoderm Fibrous tissue (connective) Cartilage Bone Muscle Fat Endoderm Gut Liver Lung Pancreas
  6. 6. Dermis <ul><li>Connective Tissue = Cells + ECMatrix </li></ul><ul><li>Connective tissue is often used to describe the extracellular matrix plus the cells found in it, such as fibroblasts, macrophages, and mast cells. </li></ul>
  7. 7. ECM Structure <ul><li>3 major fiber-forming proteins: </li></ul><ul><li>Collagen, elastin, and fibronectin </li></ul><ul><li>GAG : Hyaluronic acid one of 7. </li></ul><ul><li>Proteoglycans. </li></ul>
  8. 8. Mesotherapy <ul><li>Connective Tissue Shock Therapy </li></ul>
  9. 9. How To Start <ul><li>Materials </li></ul><ul><li>Injection sites </li></ul><ul><li>Injection Depths </li></ul><ul><li>Needle size </li></ul><ul><li>Machine </li></ul>
  10. 10. Mesotherapy in Depth <ul><li>Non-prescription treatment. </li></ul><ul><li>Non Conventional Safe Aesthetic Procedure. </li></ul><ul><li>Should rely on E vidence B ased M edicine.To achieve good results. </li></ul><ul><li>Depend on Used Meostherapy Materials. </li></ul>
  11. 11. Mesotherapy Materials Classification <ul><li>A. Principals : </li></ul><ul><li>Ingredients that have been used orally or topically or injectable for treatment of each indication/condition. </li></ul>
  12. 12. Mesotherapy Materials Classification <ul><li>A. Principals : </li></ul><ul><li>Ingredients with high grade of evidence in treatment of each indication/condition. </li></ul><ul><li>Ingredients that have been FDA Approved for treatment of each indication/condition. </li></ul>
  13. 13. Mesotherapy Materials Classification <ul><li>B. Complementary : </li></ul><ul><li>Ingredients that have been claimed to improve the condition. </li></ul>
  14. 14. Ideal Mixtures <ul><li>Mixtures should contain </li></ul><ul><li>2-3 principals to achieve satisfactory </li></ul><ul><li>results(>90%). </li></ul>
  15. 15. Mesotherapy <ul><li>Indications: </li></ul><ul><li>Hair : Hair Loss & AGA. </li></ul><ul><li>Facial Rejuvenation. </li></ul><ul><li>Facial Pigmentation. </li></ul><ul><li>Body Sculpting. </li></ul>
  16. 16. I. Hair <ul><li>Telogen Effluvium </li></ul><ul><li>Hair Growth Stimulants </li></ul>Principals Complementary <ul><ul><li>Biotin </li></ul></ul><ul><ul><li>( Vitamin H/ B7) </li></ul></ul><ul><ul><li>Pantothenic acid </li></ul></ul><ul><ul><li>( Vitamin B5) </li></ul></ul><ul><ul><li>Pyridoxine </li></ul></ul><ul><ul><li>( Vitamin B6) </li></ul></ul><ul><ul><li>Zinc + Azelaic acid </li></ul></ul><ul><ul><li>MV + MTE </li></ul></ul>
  17. 17. I. Hair <ul><li>AGA </li></ul><ul><li>Hair Growth Stimulants </li></ul><ul><ul><li>5-ARI </li></ul></ul>Androgenetic Alopecia (AGA) Principals Complementary <ul><ul><li>Minoxidil </li></ul></ul><ul><ul><li>Finasteride </li></ul></ul><ul><ul><li>Dutasteride </li></ul></ul><ul><ul><li>Zinc + Azelaic acid </li></ul></ul>
  18. 18. Minoxidil <ul><li>Mechanism of action is unknown. </li></ul><ul><li>Appears to lengthen the duration of the anagen ( growth ) phase of hair . </li></ul><ul><li>It may increase the blood supply to the follicle. </li></ul><ul><li>AGA: Hair regrowth is more pronounced on the crown as well as the frontal scalp which is noted on at least 12 sessions. </li></ul>
  19. 19. 5 alpha Reductase Inhibitors Dutasteride Acts on the two isomers of the enzyme 5 alpha reductase thus it is effective in both males and females . Acts against one isomer only iso-enzyme II thus it is ineffective in females Finasteride Does not give any burning sensations during the injection Very painful and give burning sensation The potency of dutasteride is greater than that of Finasteride Lower potency than Dutasteride
  20. 20. MesoHair Protocols Telogen Effluvium Androgenetic Alopecia Biotin (P) Dexenol(P) MV + MTE (C) Minoxidil(P) / Dutasteride(P) + Biotin(P) Dexenol(P) Zinc + Azelaic (C)
  21. 21. MesoHair Injection sites & depths
  22. 22. II. Face MesoLift / MesoGlow <ul><li>Rejuvenation ( Principals ) </li></ul><ul><ul><li>Hyaluronic acid </li></ul></ul><ul><ul><li>Amino acids </li></ul></ul><ul><ul><li>Vitamin C </li></ul></ul><ul><ul><li>DMAE </li></ul></ul><ul><ul><li>Organic Silicium </li></ul></ul><ul><ul><li>Fibronectin + Vegetal proteins (Collagen & Elastin) </li></ul></ul>
  23. 23. II. Face MesoLift / MesoGlow <ul><li>Rejuvenation ( Complementary ) </li></ul><ul><ul><li>Vitamin A </li></ul></ul><ul><ul><li>Glycolic acid </li></ul></ul><ul><ul><li>Taurine </li></ul></ul><ul><ul><li>XADN </li></ul></ul><ul><ul><li>MV & MTE </li></ul></ul>
  24. 24. Rejuvenating Principals <ul><li>Hyaluronic acid: </li></ul><ul><li>maintain hydration + elasticity of skin </li></ul><ul><li>Amino acids : </li></ul><ul><li>improve skin tone+ firmness + elasticity. </li></ul><ul><li>essential to compensate the reduced fibroblasts activity. </li></ul><ul><li>Vitamin C : </li></ul><ul><li>The only antioxidant that is proven to stimulate the synthesis of collagen </li></ul>
  25. 25. Rejuvenating Principals <ul><li>DMAE : </li></ul><ul><li>Potent firming acts quickly and lasts long. </li></ul><ul><li>Acts in the neuromuscular union, as a precursor of acetylcholine, the neurotransmitter responsible for muscular contraction, increasing the overall tone of the skin. </li></ul>
  26. 26. Rejuvenating Principals <ul><li>Organic Silicium/Silorg : </li></ul><ul><li>maintain ECM Hydration + Tone and Elasticity of skin </li></ul><ul><li>Fibronectin +Vegetal proteins ( Elastin and Collagen ) : </li></ul><ul><li>restore ECM components (fibronectin , collagen and elastin). </li></ul>
  27. 27. Complementary <ul><li>Retinol/Vitamin A : </li></ul><ul><li>restore collagen and elastin. </li></ul><ul><li>Glycolic : </li></ul><ul><li>stimulating new growth of collagen. </li></ul><ul><li>Taurine : Antioxidant </li></ul><ul><li>helps collagenogenesis-----increases hydroxyproline dermal concentration. </li></ul>
  28. 28. Complementary <ul><li>MV + MTE : </li></ul><ul><li>Activate the biochemical reactions. </li></ul><ul><li>XADN : </li></ul><ul><li>composed of Procaine, Thiamine (Vitamin B1), Riboflavin (B2), Niacin (B3)Pantothenic Acid (B5), Pyridoxine (B6). Improve speed of metabolic reactions. </li></ul>
  29. 29. MesoGlow Protocols Hyalift HA Silorg Purascorbol / Vitamin C Xadenal Hyalift Silorgamine = Silorg + DMAE Puretinol / Vitamin A Taurinox
  30. 30. MesoGlow Protocols Fibronectin Elastine Collagen Silorg DMAE Vitamin C HA Silorg
  31. 31. MesoGlow Injection sites & depths
  32. 32. III. Face Pigmentation <ul><li>MesoLighten / Depigmenting Principals </li></ul><ul><ul><li>Glutathione. </li></ul></ul><ul><ul><li>Kojic acid. </li></ul></ul><ul><ul><li>Azelaic acid. </li></ul></ul><ul><ul><li>Vitamin C. </li></ul></ul><ul><ul><li>Tretinoin. </li></ul></ul>
  33. 33. MesoLighten Protocols Kojic acid Azelaic acid Tretinoin Vitamin C with/without Hyaluronic / silorg Glutathione Vitamin C Kojic acid Glycolic acid
  34. 34. MesoLighten Injection sites & depths
  35. 35. MesoLighten Injection sites
  36. 36. MesoLighten Injection sites
  37. 37. MesoLighten
  38. 38. IV. Body Sculpting <ul><li>Localized Fat. </li></ul><ul><li>Cellulite. </li></ul><ul><li>Stretch marks. </li></ul>
  39. 39. A. Localized Fat <ul><li>LipoDissolve </li></ul><ul><li>Injection Lipolysis </li></ul>
  40. 40. Localized Fat ICCM / IAAL Injection Lipolysis Mesotherapy Deep 12mm PPC + DOC (PCDC) Hyaluronidase-Collagenase- Artichoke Intermediate 6mm (L-Carnitine-Aminophylline- Yohimbine- Artichoke) 2 - 4 mm L-Carnitine Aminophylline Pentoxifylline Effective complement
  41. 41. Phosphatidyl Choline (PPC) <ul><li>An antioxidant derived from soy lecithin. </li></ul><ul><li>PPC penetrates the adipocyte , breaks </li></ul><ul><li>down fat . Dissolved fat is carried through bloodstream and excreted by kidneys and bowel. </li></ul><ul><li>LipoDissolve + proper diet + Exercise. </li></ul>
  42. 42. Localized Fat/ Injection Lipolysis <ul><li>Lipolytic Enhancers : </li></ul><ul><li>Deoxycholate: Bile salt </li></ul><ul><li>L-Carnitine: Enhances both lipolysis and fatty acid oxidation . </li></ul><ul><li>Artichoke: Direct lipolytic </li></ul><ul><li>Hyaluronidase & Collagenase: PPC enhancer Enzymes. </li></ul><ul><li>Aminophylline , Caffeine & Xanthine. </li></ul>
  43. 43. Localized Fat/ Injection Lipolysis <ul><li>Circulatory Enhancers : </li></ul><ul><li>Yohimbine:Alpha2-adrenergic Blocker. </li></ul><ul><li>Aminophylline &Pentoxiphylline: PDEI </li></ul><ul><li>Drainage Enhancers : </li></ul><ul><li>Artichoke:Diuretic and stimulates lymphatic drainage </li></ul>
  44. 44. Localized Fat/ Injection Lipolysis Protocols <ul><li> </li></ul><ul><li>Phosphatidylcholine </li></ul><ul><li>Deoxycholic Acid </li></ul><ul><li>Vitamin complex </li></ul><ul><li>Alpha Lipoic Acid </li></ul><ul><li>Amino Acids </li></ul>Phosphatidylcholine Deoxycholic Acid Taurine Organic silicium Phosphatidylcholine Deoxycholic Acid L-Carnintine Aminophylline Pantothenic Acid
  45. 45. Localized Fat/ Injection Lipolysis Protocols Phosphatidylcholine L-Carnitine Procaine Phosphatidylcholine Caffeine Yohimbine Procaine
  46. 46. LipoDissolve Injection sites & depths
  47. 47. LipoDissolve Injection sites
  48. 48. LipoDissolve Injection sites
  49. 49. B. Cellulite <ul><ul><li>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”. </li></ul></ul>
  50. 50. Cellulite
  51. 51. Cellulite
  52. 52. Cellulite <ul><ul><li>Treatment must act in two different ways: </li></ul></ul><ul><ul><li>on the fat (Lipolytic effect) </li></ul></ul><ul><ul><li>on circulation (Venotonic effect + Drainage) </li></ul></ul>
  53. 53. Cellulite <ul><li>Lipolytic : </li></ul><ul><li>L- Carnitine + Caffeine . </li></ul><ul><li>Venostatic : </li></ul><ul><li>Rutin – Aminophylline –Pentoxiphylline. </li></ul><ul><li>Drainage : </li></ul><ul><li>Artichoke. </li></ul>
  54. 54. Cellulite Protocols <ul><li>L- Carnitine </li></ul><ul><li>Aminophylline </li></ul><ul><li>Pentoxiphylline </li></ul><ul><li>Yohimbine </li></ul><ul><li>DMAE </li></ul><ul><li>Procaine </li></ul><ul><li>L- Carnitine </li></ul><ul><li>Aminophylline </li></ul><ul><li>Pentoxiphylline </li></ul><ul><li>DMAE </li></ul><ul><li>Vitamin C </li></ul><ul><li>Procaine </li></ul><ul><li> </li></ul>
  55. 55. MesoCellulite Injection sites
  56. 56. MesoCellulite
  57. 57. C. Stretch Marks <ul><li>The connective tissue, including collagen and elastin, becomes increasingly damaged until eventually causing the formation of stretch marks. </li></ul>
  58. 58. Stretch Marks <ul><ul><li>Collagen Elastin Stimulating/ Restoring agents </li></ul></ul><ul><ul><li>Organic Silicium / Silorg </li></ul></ul><ul><ul><li>Centella Asiatica </li></ul></ul><ul><ul><li>Vegetal proteins + Fibronectin </li></ul></ul><ul><ul><li>Firming agents </li></ul></ul><ul><ul><li>DMAE + Vitamin C </li></ul></ul><ul><ul><li>DMAE + Idebenone. </li></ul></ul>
  59. 59. MesoStretch Marks Protocols <ul><li>Silorgamine = </li></ul><ul><li>Silorg + DMAE </li></ul><ul><li> </li></ul><ul><li>Centella Asiatica </li></ul><ul><li>Fibronectin </li></ul><ul><li>Vegetal Proteins </li></ul><ul><li>Idebe = </li></ul><ul><li>Idebenone + DMAE </li></ul><ul><li>Vitamin C </li></ul><ul><li>DMAE </li></ul><ul><li>Silorg </li></ul>
  60. 60. MesoStretch Marks Injection sites
  61. 61. Needle size <ul><ul><li>30/32 G x 4 mm </li></ul></ul><ul><ul><li>30/32 G x 6 mm </li></ul></ul><ul><ul><li>30/32 G x 12.7 mm </li></ul></ul>
  62. 62. MesoGuns
  63. 63. Injection Techniques <ul><li>PAPULE: </li></ul><ul><li>1 to 2mm, with bevel upwards </li></ul><ul><li>NAPPAGE: </li></ul><ul><li>2 to 4mm, angle of 30° to 60° </li></ul><ul><li>POINT BY POINT: </li></ul><ul><li>deep injections , 4 to 12mm </li></ul>
  64. 64. Contraindications <ul><li>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. </li></ul>
  65. 65. MESOPORATION <ul><li>A new complex process utilizes the skin's water based &quot;channels&quot; to allow ionic drug solutions to penetrate into the skin, via controlled &quot; electroporation - like &quot; electrical pulses. </li></ul>
  66. 66. MESOPORATION <ul><li>Applications are same as Mesotherapy. </li></ul><ul><li>No needles are required. </li></ul>
  68. 68. Thank You