A.A.G.P.
Wiraguna
MESOTHERAPY
MESOTHERAPY
Pioneered in1952 by French doctor Dr Michael Pistor.
Its superficial subcutaneous injection of low dose of
medications
Directly injecting drugs to affected sites
Skin is used as a drug administration organ
It promotes the body’s circulatory, lymphatics and immune
system to create a biological response and reverse abnormal
physiology
MESOTHERAPY
Many different types of drugs used
Many different brands and manufacturers
Beware of quality of drugs
Ensure that production is TGA and/or FDA certified
INDICATIONS
Cosmetic indications
Medical indications
COSMETIC AESTHETIC INDICATIONS
Obesity, weight loss
Cellulite reduction
Face and neck rejuvenation (Mesolift)
Body sculpturing (good in conjunction with liposuction)
Hair loss and Alopecia
MEDICAL INDICATIONS
Muscle spasms
Stress
Insomnia
Carpal tunnel
Tennis elbow
Fibromyalgia
Osteoarthritis
Migraines
Sports injuries
Others
MESOTHERAPY
Doctors need to know pharmacology
Get good products.
Products production quality control in important
Need to ensure ingredients are TGA/FDA approved
MESOTHERAPY
Drugs are administered superficial to avoid resorption and
hence remain localised to area of injection
Superficial subcutaneous
Always use mesotherapy drugs with procaine
But avoid cocktails, avoid mixtures when just starting.
GENERAL TECHNIQUE
Mechanical or electronic injection
30G needle
Syringe 1 ml to 10ml
Depth of injection : 2mm to 6mm deep, up to 13mm
Intradermal and subcutaneous depending on substance
Angle 30 degrees to 60 degrees
Distance 0.5cm(face) to 2cm(body) apart
Dose : variable to each product (usually 0.1ml-0.3ml)
Schedule : variable (usually weekly for 10 weeks then
monthly maintenance)
GENERAL TECHNIQUE
Nappage Technique
Multiple points of injections very close, 2 to 4 mm apart
Angle of needle 30-60 degrees, in parallel lines using a 4
or 14 mm needle and regular pressure
PRECAUTIONS
Avoid enzymes for beginners
mucopolysaccharides/mucoperoxidase
destroys lymphatics hence cause edema
Avoid cocktails for beginners
Avoid too deep as have systemic effect
For phosphotidylcholine, avoid 2mm deep as cause necrosis,
hence 4mm-13mm
Advise to use Meso-gun to get right dose and depth
COMPLICATIONS
Pain
General effects
Flushing/vagal response/allergy/nauseas
Hematoma/bruise
Infection
Necrosis
Staining from iron
Did not work
Non responders
PHARMACOLOGY
Drugs must be
-isotonic
-water soluble
-non allergenic
-becareful when use enzyme (destroy
lymphatics hence edema)
-non oil base as will cause granuloma
-do not cause
-nodules/abscess or necrosis
Many different type of drugs used
PHARMACOLOGY
Vasodilators (increase circulations)
NSAID (anti-inflammatory)
CNS sedatives (muscle relaxant)
Enzymes (decrease scar tissue)
Nutrients (stimulate repair)
Vaccines (stimulate immune system)
Antibiotics (anti-infection)
Hormones (hormone replacements)
Hormone blockers (Hair growth)
Anaesthetics (increase circulation)
Others
PHARMACOLOGY
Multiple pharmacological effects such as
Alpha adrenergic receptor blockade
-vasodilation
-lipolysis
Insulin receptors
Peptide receptors
Anaesthetic effects
Restoring microcirculation
MESOTHERAPY DRUGS
Alkaloids
Methylxanthine
Aminophyline
Penthoxyphyline
Caffiene
Alpha adrenergic blocks
-cause vasodilatation hence Increase drainage
L-carnithine
-works on mitochondria hence increase metabolism
Phosphotidylcholine
Procaine
-local anaesthetic effect
-restore normal function of cell
Amino acids
Others
PHARMACOLOGY
Weight lost
Caffiene
Aminophylline
Yohimbine
L-carnithine
Phosphatidylcholine
Vascular/circulation
Prociane
Facial rejuvenation
17 B Estradiol
Glycolic acid
Hyaluronic acid
Vitamin C
CAFFEINE
An alkaloid
Structurally related to methyxanthines alkaloids,
theophylline and theobromide
Is a bronchial smooth muscle relaxant, CNS stimulant, a
cardiac muscle stimulant and a diuretic
Aminophylline and caffiene are active ingredient of most
cellulite cream
Action
Increase blood flow
Stimulate fat cells to release lipids and promote cellular drainage
Tightens and tones skin
AMINOPHYLLINE
An alkaloid
is a mixture of theophylline and ethylenediamine
Must be kept in cool dark place
Action
Promotes fat breakdown
Increase blood flow by dilating blood vessels
PHOSPHATIDYLCHOLINE
Most abundant phospholipid component in all cells
A “fat burner” hence “melts away” fat and cellulite
Use widely for weight lost programme
Main role in cell-membrane integrity
Action
Increase cholesterol solubility
Alter composition of fat deposits
Inhibits plaque aggregation
YOHIMBINE
Alkaloid
An aphrodisiac
Action
Block alpha2-adrenergic receptors hence increase blood
flow via vasodilatation
L-CARNITINE
Classed as amino acid
Facilitate long-chain fatty acid entry into cellular
mitochondria, hence delivering substrate for
oxidation and subsequent energy production
Fatty acids are utilized as energy substrate in all
tissue (except brain)
Action
Helps metabolize stored fats into energy during
physical activity
PROCAINE
Well known, safe , non-toxic local anaesthetic since 1905
Action
Local anesthetic effects
Restore normal functioning of damage tissue
Enhance absorption if other druges that it is injected with
17 B ESTRADIOL
A hormone from wild yam
Most commonly used source of estrogen for natural HRT
Relatively small lipid soluble molecule, hence easily
absorbed by skin
Actions
Stimulates proliferation of fibroblast
Stimulates new collagen formation
Influences the turn-over of macro-molecules
GLYCOLIC ACID
Alpha Hydroxy Acids (AHAs)
From sugar cane
Actions
Stimulate new growth of skin and collagen
Decreasing the bond that holds dead skin cells on suface
HYALURONIC ACID
A natural living substance
Used in treatment of aged and dehydrated skin
VITAMIN C
Used in stretch marks and skin rejuvenation
Widely used in creams and injectables
Actions
Collagen formation
Anti-oxidant
Key immune system nutrients
MAIN MESOTHERAPY TREATMENTS
1) Cellulite treatment
2) Fat reduction
3) Mesolift
CELLULITE TREATMENT
Injection depth 2-4mm
Injections points 2 cm apart
Injection technique bevel up, alcohol
Schedule of procedure
1 week apart
2 weeks apart if also use PPC
Primary cocktail
yohimbe/aminophylline/procaine/DMAE/Pentoxifylline
(2mls each)
Dosage
All in 1 syringe, may use 2-4 syringes depending on size
FAT REDUCTION TREATMENT
Injection Depth 13mm deep
Injection Points 2-4cm apart
Injection Technique
bevel up
manual injection with syringe with PPC
Schedule of procedure
2-3 weeks apart
Cellulite and skin treatments can be administered in
between these sessions
Average 5-10 treatments
FAT REDUCTION TREATMENT
Ingredients
Phosphatydylcholine(PPC) 100mg/ml
Procaine 20mg/ml
FAT REDUCTION TREATMENT
Dosage
Max dose per session over multiple area : 2500mg PPC
1st session <500mg to assess S/E
PPC should always used in 50mg/ml concentration**
Inject 20mg(0.4ml) PPC at each site
Lidocaine or Procaine is to be used with PPC at 50:50**
Hence 1ml PPC + 1ml 1% Procaine (used within 24 hours)
50ml bottle mix 25ml 100mg/ml PPC + 25ml of Procaine 1%
Equals 2500mg PPC in 50ml bottle=10 x5mls syringes
At 20mg(0.4ml) per injection, therefore, no more than 130 injection
points
No massage or rubbing for 12 hours
FAT REDUCTION TREATMENT
Contraindicated
Children
Pregnant women, nursing mother
Diabetics with vascular problmes
Autoimmune disease
Liver disease
Severe obesity
Acute or Chronic infection
S/E
Swelling, redness and soreness
Suggest wear loose clothes for 2-3 days
MESOLIFT
Injection Depth 2-4mm deep
Injection Points point to point / Nappage
Injection Technique intradermal
Schedule of procedure
Weekly sessions
Minimun of 10 sessions
MESOLIFT
Benefits of mesolift
Skin revitalizing
Nutritional improvement
Hydration improvement
Fibroblast stimulation
Increase collagen production
Free radicals blocking
Hydrating action
Restore skin tone
Restore dermoepidermic cohesion
MESOLIFT
Suggested cocktail
Week 1
Syringe 1 (x)
17 B Estradiol 1.0ml
Procaine 2% 2.0ml
Syringe 2 (o)
Vitamin C 222mg/ml 3.0ml
Lidocaine 1% 2.0ml
Week 2
Syringe 1 (x)
17 B Estradiol
Procaine 2% 2.0ml
Syringe 2 (o)
GAG 0.5ml
Hyuralonic acid 2.0ml
Trissilinol 0.5% 2.0ml
Lidocaine 1% 2.0ml
IMPORTANT POINTS
If you don’t know, avoid mixtures
It is better to use one drug at a time, plus Procaine 2%
Small amounts at many points
One session/week
One or two session/month for maintenance
Intradermic 2-4 mm superficial level of injections
MESOTHERAPY
Multiple usage
Doctors should start slow
Get to know your drugs/cocktails
Improve your techniques
Use a meso-gun
Start off with cellulite treatment, fat reduction and mesolift
Use mesotherapy together with chemical peel,
microdermabrasion, dermal fillers, lasers, IPL, liposuction.
THANK YOU
