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Dr. Hasan Ali Nogay M.D. UNDERWATER and HYPERBARIC MEDICINE SPECIALIST MEDICAL ESTHETICIAN MESOTHERAPIST ADDRESS : Demircikara mh. Avni Tolnay Cad. No:46/1, Narenciye Antalya-TÜRKİYE TEL. : +90.242.322.00.99 e-mail : www.drnogay.com 1 HISTORY OF MESOTHERAPY 1952 : • Dr PISTOR PERFORMS AN INTRAVENOUS INJECTION OF 10 ml OF PROCAINE TO AN ASTHMATIC PERSON. • HIS SHORTNESS OF BREATH DOES NOT IMPROVE, BUT HIS DEAFNESS DECREASED. • Dr PISTOR THEN HAS THE SIMPLE BUT BRILLIANT IDEA OF INJECTING SMALL DOSES OF PROCAIN FROM 3 TO 5 MM DEEP AROUND THE PATIENT’S EAR. • THIS THERAPY PROVES TO BE MORE EFFICIENT THAN WHEN GIVEN SYSTEMICALLY. 2 HISTORY OF MESOTHERAPY 1958 • THE NAME MESOTHERAPY IS SUGGESTED IN THE FRENCH MEDICAL PRESS. • FOR Dr PISTOR, HIS TREATMENT MODALITY SEEMED ACTIVE ON THE MESODERM AND ITS DERIVATES ; THEREFORE THE TERM “MESO”. 1976 • CONSULTATIONS OF MESOTHERAPY ARE PERFORMEDBY Dr DALLOZ- BOURGUIGNON IN NECKER’S HOSPITAL (PARIS). 1981 • FIRST MESOTHERAPY CONSULTATION FOR PROFESSIONAL ATHLETES (INSTIITUT NATIONAL DES SPORTS DE PARIS) Y. DEMARAIS’SERVICE , PERFORMED BY Dr. J. LE COZ. 3 HISTORY OF MESOTHERAPY 1982 FIRST UNIVERSITY DIPLOMA IN MESOTHERAPY AT THE FACULTY OF MEDICINE OF PARIS XIII (Dr. M. BICHERON). 1987 • MESOTHERAPY IS OFFICIALLY RECOGNIZED AS PART OF TRADITIONAL MEDICINE. 1991 • CREATION OF SOCIETE FRANCAISE DE MESOTHERAPIE (1600 MEMBERS). 2002 • MESOTHERAPY IS TAUGHT AT THE FACULTY OF MEDICINE IN MARSEILLE, BORDEAUX, PARIS. • FRENCH HEALTH SYSTEM RECOGNIZES THE MESOTHERAPY ACT. 4 HISTORY OF MESOTHERAPY 2003 • DEATH OF Dr MICHEL PISTOR WHO WAS A PASSIONATE INVENTOR, A POET AND A HUMANIST, DURING HIS WHOLE LIFE. 2004 • IN FRANCE, APPROXIMATELY 15 000 DOCTORS USE MESOTHERAPY DAILY AND UP TO 60 000 PERSONS ARE TREATED BY MESOTHERAPY EVERY DAY. 5 DEFINITIONS OF MESOTHERAPY DR PISTOR QUOTE : « A LITTLE, RARELY, IN THE RIGHT SPOT » IS STILL TRUE. • A LITTLE: IN MESOTHERAPY, SMALL DOSES OF DRUGS ARE ADMINISTERED. MESOTHERAPY GIVES THE OPPORTUNITY OFCOMBINING BETWEEN TWO TO FIVE DRUGS WITH A SIMPLE INJECTION. • RARELY: INITIALLY, MESOTHERAPY SHOULD NOT BE PERFORMED MORE THAN ONCE A WEEK (FROM 2 TO 6 SESSIONS) . AFTER, THE OTHER SESSIONS CAN BE DONE EVERY FIFTEEN DAYS AND “UP KEEP” SESSIONS EVERY MONTH. • IN THE RIGHT SPOT: MESOTHERAPY IS PRACTICED WITH INJECTIONS AT THE SITE OF PAIN OR PATHOLOGY 6 DEFINITIONS OF MESOTHERAPY MESOTHERAPY IS A MEDICAL TECHNIQUE • IT CONSISTS OF DERMO-EPIDERMIC INJECTIONS (1 TO 13 MM DEEP) • USUALLY OF ALLOPATHIC PRODUCTS VARYING WITH THE PATHOLOGY TO BE TREATED. • WITH SMALL DOSES OF DRUGS, WE OBTAIN AN EFFECTIVE MAXIMALE CONCENTRATION. • THE SYSTEMIC, GASTRIC AND HEPATIC PASSAGE IS MINIMAL WHICH RESULTS IN ALMOST ABSOLUTE SAFETY. 7 MESOTHERAPY GENERALITIES MESOTHERAPY IS A TREATMENT STIMULATING THE MESODERM OR MIDDLE LAYER OF THE SKIN. • CONCERNING AESTHETIC MEDICINE : – CELLULITE – WEIGHT LOSS – BODY SCULPTING – HAIR LOSS – FACE AND NECK REJUVENATION RESPOND WELL TO MESOTHERAPY • MESOTHERAPY INVOLVES : – THE INJECTION OF A CUSTOMIZED MIXTURE WITH EXTREMELY SMALL NEEDLES (GENERALLY 4 TO 6 MM). – JUST A DROP OF THE SOLUTION : IS PLACED AT EACH INJECTION SITE. – ONLY INTO THE PROBLEMATIC AREA. • THE PROCEDURE : – IS REALY PAINLESS – REQUIRES NO PREPARATION OR RECOVERY TIME, NO BANDAGES, NO INTERRUPTION OF THE DAILY LIFE. • SIDE EFFECTS : – GENERALLY LIMITED TO BRUISING (WHEN DHD TECHNIQUE IS USED WITH A DEPTH OF 10 MM). – IT IS A SAFE TREATMENT, WHEN PERFORMED BY AN EXPERIENCED CLINICIAN. 8 DIFFERENT TECHNIQUES OF INJECTION EPIDERMIC MESOTHERAPY DERIVATE OF MULTIPRICKING NO BLEEDING THE EDGE OF THE NEEDLE DIRECTED UPWARD MOVEMENT BACKWARD AND FOWARD MOTION IN THE AXE OF THE NEEDLE “NAPPAGE” : MULTI-PRICKING A THIRD OF THE CONTENTS OF THE SYRINGE IS INJECTED THE REST IS LOST PAPULA “POINT BY POINT” WE PRICK, WE INJECT, WE REMOVE THE NEEDLE 9 TERMINOLOGY RESULTING FROM CONSENSUS OF SCIENTIFIC COMITEE OF SOCIETE FRANCAISE DE MESOTHERAPIE (S.F.M.) • IED : INTRAEPIDERMIC INJECTION : 1 MM • ID : INTRADERMIC INJECTION : 1 to 4 MM OF DEPTH • IDS : SUPERFICIAL INTRADERMIC: 1 to 2 MM (NAPPAGE) • IDP : DEEP INTRADERMIC INJECTION : 3 to 4 MM • DHP : DERMO HYPODERMIC : 2 to 10 MM • PPP : POINT BY POINT : 2 to 4 MM 10 MESOTHERAPY TECHNIQUE • NO AGGRESSIVE INJECTION. • NO INJECTION DEEPER THAN 10 MM. • NO MIXTURE CONTAINING MORE THAN 4 OR 5 DRUGS. • A LITTLE, RARELY, IN THE RIGHT SPOT. • MATERIAL USED ONLY ONCE. • DISINFECTION OF THE INJECTED AREA WITH CHLORHEXIDINE OR BENZYLIC ALCOHOL. • WEARING GLOVES IS RECOMMENDED. • A GOOD SESSION MUST BE PAINLESS AND LEAVE MINIMAL OR NO MARKS AT ALL. 11 MATERIAL USE • MULTI-INJECTORS AND MULTI-PUNCTURE HAVE BEEN ABANDONED. • REPLACED BY THE SIMPLER SINGLE NEEDLE MEASURING 4, 6 OR 13 MM, TO BE USED ONCE ONLY. • THE NEEDLE IS FASTENED INTO A SYRINGE WHOSE VOLUME VARIES BETWEEN 2 AND 10 CC. • THIS MATERIAL CAN EITHER BE USED MANUALLY OR MOUNTED INTO AN ELECTRONIC OR MECHANICAL INJECTOR (DHN, PISTOR 3 OR 4, MESO SYSTEM). 12 MESO-SYSTEM MESOTHERAPY GUN • THIS GUN “MESO-SYSTEM” INTEGRATES THE MORE RECENT TECHNOLOGY APPLIED TO MESOTHERAPY. • SPEED AND FREQUENCY OF THE INJECTION ARE CONTROLLED ELECTRONONICALLY. • IT IS CONTROLLED BY MICRO-PROCESSOR AND WE HAVE 8 INJECTION PROGRAMS. • AUTOMATIC PRESSION ADJUSTMENT OF THE SYRINGE, ELECTRONIC CONTROL OF DEPTH AND DOSE. • RECHARGEABLE BATTERY INTEGRATED. • AUTONOMY OF 6 HOURS IN CONTINUOUS USE. • “MESO-SYSTEM” ACCEPTS ANY KIND OF SYRINGES AND NEEDLES. NO EXCLUSIVE KIT. 13 SECURITY MEASURES • BEFORE THE SESSION : • THROUGH QUESTIONING TO DISCOVER ANY HISTORY OF ALLERGIES. • ONGOING TREATMENTS. • EXISTENCE OF ACUTE OR CHRONIC PATHOLOGY. • ANTI-COAGULANT TREATMENT. • THE PATIENT MUST STOP ANY TREATMENT WITH ASPIRIN OR ANTI-INFLAMMATORY MEDICATION TWO DAYS BEFORE THE PROCEDURE. • AFTER THE SESSION : • NO BATH OR SHOWER. • NO CREAM AND HYDRATING MILK. • AVOID THE SUN FOR ONE DAY. 14 MEDICATIONS IN MESOTHERAPY • IN GENERAL, BETWEEN TWO AND FIVE DRUGS ARE MIXED AND INJECTED AT THE SAME TIME. • THEIR CHEMICAL AND PHYSICAL COMPATIBILITY HAVE BEEN TESTED. • IN THE BEGINNING, ALMOST ALL MEDICATIONS INJECTED INCLUDED PROCAÏNE. • THIS PRODUCT WAS USED FOR ITS SYMPATHICOLYTIC AND VASODILATATION PROPERTIES. • ITS USE, HOWEVER, WAS HIGHLY DEBATED DUE TO ITS HIGH ALLERGIC RISK BROUGHT BY PARAAMINOBENZOATE. • IN FRANCE, PHYSICIANS PRATICING MESOTHERAPY HAVE NEVER ENCOUNTERED PROCAÏNE-LINKED ANAPHYLACTIC SHOCKS (THE MINIMUM DOSE INJECTED CAN NOT BE CONSIDERED AGGRESSIVE). 15 DRUGS USED IN MESOTHERAPY MUST: • BE APPROVED BY FRENCH DRUG AGENCY IN ORDER TO BE INJECTED. • BE PACKAGED IN STERIL AMPULES. • BE PREPARED JUST BEFORE THE SESSION. 16 VASODILATORS DIHYDROERGOTAMINE (D.H.E.) • PACKAGE : AMPULE OF 2 ML (1 mg) • INDICATIONS IN USE OF MESOTHERAPY : – MIGRAINES – VENO-LYMPHATIC DEFICIENCY • MESO INJECTION TECHNIQUE : – IDS. • CONTRA-INDICATION : – PREGNANCY 17 VASODILATORS ETAMSYLATE ( DYCINONE) • PACKAGE : AMPULE OF 2 ML • INDICATIONS IN USE OF MESOTHERAPY : – LOCAL EDEMA AS VEINOTONIC. • MESO INJECTION TECHNIQUES: – IED, IDS, IDP, DHD. • UNDESIRABLE EFFECTS : – SKIN ALLERGY. 18 PROCAINE PROCAINE BIOSTABILEX 2 % • PACKAGE : AMPULE OF 5 ML (100 mg) • VALIDATE INDICATIONS : LOCAL ANESTHESIC • INDICATIONS IN USE OF MESOTHERAPY : – VASODILATOR ACTION • CONTRA-INDICATIONS : – EPILEPSY – PROCAINE ALLERGY – PREGNANCY • UNDESIRABLE EFFECTS : – EXCEPTIONNAL ALLERGY – CARDIO-VASCULAR COLLAPSE – CONVULSIONS – CARDIAC ARYTHMIS 19 LIDOCAINE (WITHOUT PARABEN CONSERVATOR) : MESOCAINE PACKAGE : AMPULE OF 5 ML : 0.5 % AND 1 % (25 MG and 50 MG) INDICATIONS : LOCAL ANESTHESIC INDICATIONS IN USE OF MESOTHERAPY : VASODILATOR ACTION USE WHEN ALLERGIC SUSPICION RISK WITH PROCAINE UNDESIRALE EFFECTS : RARE ALLERGY 20 VASODILATORS PRODUCTS BUFLOMEDIL (FONZYLANE) • PACKAGE : AMPULE OF 5 ML (50 mg) • INDICATIONS : – PERIPHERAL VASODILATOR. • MESO INJECTION TECHNIQUES: – IED, IDS, IDP, DHD, NAPPAGE, PPP. • CONTRA-INDICATION : – EXCEPTIONNAL ALLERGY 21 VASODILATORS PRODUCTS PENTOXIFYLLINE (TRENTAL) • PACKAGE : AMPULE OF 5 ML (100 mg) • INDICATIONS: – PERIPHERAL VASODILATOR – ANTI-FREE RADICALS ACTION. – MESO INJECTION TECHNIQUES: IED, IDS, IDP, DHD, NAPPAGE, PPP. • UNDESIRABLE EFFECT : – SKIN ALLERGY 22 VITAMINS • VIT A, D3, E, B1, B2, PP, B6, VIT C (HYDROSOL POLYVITAMIN BON) • PACKAGE : AMPULE OF 2 ML • INDICATIONS IN USE OF MESOTHERAPY : – ANTI FREE RADICALS ACTION. • MESO INJECTION TECHNIQUES : – IED, IDS, IDP, DHD. • CONTRE-INDICATIONS : ALLERGY VIT. B1 HYPERCALCEMIA PREGNANCY 23 CALCITONINE PHARMY II 50 UT and 100 UT PACKAGE : CIBACALCINE SALMON CALCITONIN (AMPULE OF 1 ML) INDICATIONS IN USE OF MESOTHERAPY : USED FOR ITS VASOMOTOR PROPERTIES LIKE ANTIOEDEMA AND VASO MODULATOR. MESOTHERAPY INJECTION TECHNIQUE : IED, IDS, IDP. CONTRE-INDICATIONS : ALLERGIC TO CALCITONINS. UNDESIRABLE EFFECTS : NAUSEA FLUSH ITCHING PARTICULAR OBSERVATIONS : UNDESIRABLE EFFECTS ARE MORE REDUCED IN MESOTHERAPY, WHEN USING IED AND IDS TECHNIQUES. SALMON CALCITONIN IS 25 TO 50 TIMES STRONGER THAN HUMAN CALCITONIN. 24 VITAMIN C PACKAGE : LAROSCORBINE : AMPULES OF 5 ML • VITAMIN C IS A POWERFULL ANTI-OXIDIZING AGENT. • ANTI-AGEING EFFECT OF VITAMIN C AND SYNTHESIS OF COLLAGEN • TAKES PART IN SYNTHESIS OF ELASTIN. • PROTECTS VITAMIN A AGAINST OXIDATION. • PROTECTS AGAINST SUN DAMAGE. • EXEMPLE OF MIXTURE : – VITAMIN C : 3 CC – PROCAINE : 1 CC – SALIN SERUM : 6 CC 25 CONJONCTYL (ORGANIC SILICIUM AND SALICYLIC ACID) • HAS BEEN RE-COMMERCIALED IN FRANCE SINCE JUNE 2004 • PACKAGE : AMPULES OF 5 ML • PROPERTIES : – – • SILICIUM CONTROLS CELLULAR STIMULATION OF FIBROBLASTS AND PROMOTES THE REGENERATION OF COLLAGEN AND ELASTIN. INDICATIONS IN USE OF MESOTHERAPY : – – LIPOLYTIC ACTION TROPHIC ACTION : THE SKIN IS MORE FIRM, SOFT AND SMOOTH. • CONTRE-INDICATIONS : ALLERGY TO SALICYLIC ACID • CAN BE INCLUDED IN THE MIXTURES , SUCH AS : – – PROCAINE : 2 CC CONJONCTYL : 6 CC OR : – – – PROCAINE : 1 CC FONZYLANE : 4 CC CONJONCTYL : 5 CC 26 HOMEOPATHIC DRUGS WELL TOLERATED WITH MINIMAL RISK. • NEVER SIDE EFFECTS. • NEVER ALLERGY. • WITHOUT CONTRE-INDICATIONS. • NO CHIMIC INCOMPATIBILITY BETWEEN HOMEOPATHIC AND ALLOPATHIC PRODUCTS. • INJECTABLE HOMEOPATHIC DRUGS FOR CELLULITE : – – – – – • HAMAMELIS MELILOTUS CYNARA SCOLYMUS FUCUS VESICULOSUS ARNICA 4 DH ACTION ON THE VEINS 4 DH 4 DH : DRAINING ACTION AND ANTIOEDEMA. 4 DH : LIPOLYTIC ACTION 4 DH : ANTI-BRUISES ACTION EXEMPLE OF MIXTURE : – – – PROCAINE 2 % = 1 ML FUCUS = 2 ML MELILOTUS = 2 ML 27 ADVERSE EFFECTS IN MESOTHERAPY • NEGLIGABLE NUMBER OF INCIDENTS. • NO SHOCKS. • NO SERIOUS ALLERGIC RISK. • NO RISK OF SKIN INFECTION IF STERILE TECHNIQUE. (DO NOT REUSE INJECTABLE MATERIAL). • TO PREVENT SHOCK RISK, USE MESOCAINE. 28 ADVERSE EFFECTS MOST DISADVANTAGES DUE TO : • PHYSICIAN LACK OF EXPERIENCE WITH THIS TECHNIQUE (PAINFUL INJECTIONS, SCRATCHES, BRUISES, TATTOOS). • INADEQUATE DISINFECTION OR NON STERILIZED MATERIAL (SKIN INFECTIONS). • TOO MUCH REPETITIV SESSIONS, DRUGS INJECTED IN LARGE VOLUME (HEMATOM, CUTANEOUS NODULES). MINOR ADVERSE REACTIONS : • LOCAL ALLERGIES, FLUSH WITH VASODILATOR OR CALCITONIN. 29 HYPERLIPODYSTROPHY DEEP SUPERFICIAL GENERALIZED LOCALIZED FAT STEATOMERY CELLULITE 30 CELLULITE CAUSES • HEREDITY (PARENTS, SIBLINGS, RACIAL FACTORS). • HORMONE EQUILIBRUM – – – – – PREMENSTRUAL SYNDROM PUBERTY PREGNANCY MENOPAUSE BADLY ADAPTED HORMONAL TREATMENT • VENOUS AND LYMPHATIC STATE • ROLE OF NERVOUS SYSTEM • JOB (PROLONGED STATIONARY JOBS, ON THEIR FEET OR SITTING DOWN ALL DAY) • GOOD NUTRITION BALANCE – – • SUGAR AND FAT EXCESS INSUFFICIENT WATER INTAKE NO PHYSICAL EXERCISE 31 CELLULITE • IT IS CAUSED BY : – POOR CIRCULATION. – WEAKENING 0F CONNECTIVE TISSUES. – LYMPHATIC CONGESTION. • MESOTHERAPY IS TARGETED TO CORRECT THESE PROBLEMS BY : – – – – IMPROVING CIRCULATION. STRENGTHENING CONNECTIVE TISSUES. STIMULATING VENOUS AND LYMPH FLOW. BREAKING DOWN THE FAT NODULES. 32 CLINICAL CLASSIFICATION CELLULITE IS CLASSIFIED IN 4 STAGES BASED UPON ITS APPEARANCE WHILE STANDING, LAYING AND PINCHING THE SKIN. • STAGE 1 : APPEARS WHEN YOU PRESS THE SKIN. • STAGE 2 : APPEARS WHEN THE PATIENT STANDS UP. • STAGE 3 : ORANGE SKIN PEEL WHEN THE PATIENT IS LAYING DOWN. • STAGE 4 : KNOTS WHEN YOU TOUCH. 33 MEDICATIONS IN CELLULITE VASODILATORS MEDICINE DEPTH = 2 4 MM • STAGE 3 TROPHIC MEDICINE DEPTH = 2 4 MM • STAGE 4 LIPOLYTIC MEDICINE • STAGE 1 and 2 POINT BY POINT 6 MM 34 CELLULITE • MESOTHERAPY CAN BE USED TO TREAT LOCALIZED FAT DEPOSITS AND CELLULITE WITH EXCELLENT RESULTS. • TODAY, IN FRANCE, WE REGRET THAT THE FOLLOWING DRUGS ARE NO LONGER AVAILABLE : • • • • • THIOMUCASE AMINOPHYLLINE CHOPHYTOL ESBERIVEN NOWADAYS, WE USE : • LOCAL ANESTHETICS (PROCAINE OR LIDOCAINE) • VASODILATORS (FONZYLANE, TORENTAL) WHICH PLAY AN ACTIVE PART ON MICROCIRCULATION, AND SOMETIMES ON VENO-LYMPHATIC SYSTEM (DIHYDROERGOTAMINE, DYCINONE). • PHYSIOLOGICAL SALIN SERUM.. • LIPOLYTICS (CAFEINE) • AND SOMETIMES HOMEOPATHIC MEDICINES. 35 MESOTHERAPY TECHNIQUES IN LIPODYSTROPHY • EPIDERMIC INJECTION : – • SUPERFICIAL INTRADERMIC INJECTION : – • HALF DELAYED ELIMINATION, ESPECIALLY IN DIFFUSED CELLULITES. DERMO-HYPODERMIC INJECTION : – • THE PRODUCT REMAINS IN THE EPIDERM WITH SLOW DIFFUSION ; NO BRUISES. AT THE LEVEL OF DEEP FIBROSIS KNOTS. MIXED OR ALTERNATIVES INJECTIONS. 36 MEDICATIONS IN CELLULITE MESOTHERAPY • • • • • • • • • VASCULAR ACTION BENZOPIRONE (COUMARINE) BUFLOMEDIL PENTOXIFYLLINE MELILOTUS GINKO BILOBA PROCAINE LIDOCAINE CALCITONINE ETAMSYLATE 37 MEDICATIONS IN CELLULITE MESOTHERAPY TROPHIC ACTION • • • • • • • • • • • SODIUM PYRUVATE ALCACHOFA (ARTICHOKE) CENTELLA ASIATICA TRISSILINOL (CONJONCTYL) LISADOS (COLLAGENO, ELASTINA, PLACENTA) VITAMIN C HYALURONIC ACID CHONDROITINE SULFATE X-ADN PLACENTEX POLYVITAMINS 38 MEDICATIONS IN CELLULITE MESOTHERAPY LIPOLYTIC ACTION • • • • • • • • IOIMBINE TIRATRICOL AMINOPHYLLINE EUPHYLLIN L-CARNITINE CAFEINE COENZYME A LIPOSTABIL 39 CELLULITE TREATMENT TWO BASIC PRINCIPLES : • MESODRAINING : TREATMENT OF THE CIRCULATION ON VASCULAR AXIS : – LIDOCAINE – ETAMSYLATE – BUFLOMEDIL (MESOCAINE) (DYCINONE) (FONZYLANE) • MESOLYTIC : LOCAL TREATMENT : (SADDLE BAGS, ABDOMEN, HIPS) LIDOCAINE (MESOCAINE) SALMON CALCITONINE 100 U HYDROSOL POLYVITAMINE (HPV BON) 40 IN LIPODYSTROPHY • STANDARD CLINICAL STAGE (THE MOST FREQUENT) : • MESOCAINE 1 % • CALCITONINE 100 U • FONZYLANE = 2 ML = 1 ML = 2 ML • OLD CELLULITE WITH HARD KNOTS OF FIBROSIS : • MESOCAINE 1 % • CALCITONINE 100 U • HYDROSOL POLYVITAMINE BON = 2 ML = 1 ML = 2 ML • LIPODYSTROPHY WITH IMPORTANT VENO-LYMPHATIC DEFICIENCY : • MESOCAINE 1 % • CALCITONINE • DICYNONE = 1 ML = 1 ML = 3 ML 41 CELLULITE TREATMENT • OTHER MIXTURES : – LIDOCAINE (MESOCAINE) – SALMON CALCITONINE 100u – BUFLOMEDIL (FONZYLANE) • OR: – LIDOCAINE (MESOCAINE) – HYDROSOL POLYVITAMINE (HPV BON) – BUFLOMEDIL (FONZYLANE) • OR: LIDOCAINE (MESOCAINE) CALCITONINE ETAMSYLATE (DYCINONE) 42 CELLULITE TREATMENT TECHNIQUE POINT BY POINT (PPP) NEEDLE 6 MM OR 13 MM • MIXTURES : PROCAINE TRENTAL DYCINONE SALIN SERUM 2CC 2CC 2CC 2CC NEEDLE 6 MM LIDOCAINE TRENTAL DYCINONE CAFEINE ARNICA SALIN SERUM 2 CC 2 CC 2 CC 1 CC 1 CC 2 CC NEEDLE 13 MM 43 CELLULITE HOW MANY TREATMENTS ? • THE NUMBER OF MESOTHERAPY TREATMENTS NEEDED DEPENDS ON MANY VARIABLES. • MESOTHERAPY TREATMENTS ARE TYPICALLY GIVEN ONCE PER WEEK (FOUR AT SIX SESSIONS) TO ACCESS SOME RESPONSE. • AS IMPROVEMENT IS SEEN, THE PROCEDURE MAY BE DONE EVERY TWO WEEKS (FOR EXEMPLE FOUR SESSIONS DURING TWO MONTHS). • AND AFTER ONE PER MONTH. • IN GENERAL, A CHRONIC COMPLAINT LIKE CELLULITE NEEDS FIFTEEN SESSIONS OF MESOTHERAPY. 44 CELLULITE THE RESULTS • THEY DEPEND ON THE PATIENT’S BODY. • MOST OF PERSONS REQUIRES FOUR TO FIVE TREATMENTS TO BEGIN TO SEE RESULTS. • BETWEEN SESSION 4 AND 6 : LOCAL CIRCULATION IMPROVED OEDEMA AND HEAVY LEGS FEELING DECREASED. TROPHIC ACTION : SKIN MORE SUPPLE AND SMOUTH COTTAGE CHEESE APPEARANCE OF THE SKIN IMPROVED. • BETWEEN SESSION 8 AND 12 (AFTER 3 OR 4 MONTHS) : VOLUME OF CELLULITE IS REDUCED PATIENT’S CLOTHING WILL BECOME LOOSER (LOSING INCHES MORE THAN WEIGHT) 45 WEIGHT LOSS PHYSICAL EXAM OBSERVE FAT DISTRIBUTION : GYNECOID TYPE (PEAR) : WE USE (LOWER PART OF THE BODY) OFTEN - DRAINING DRUGS ASSOCIATED WITH VARICOSE VEINS - VASODILATORS - STIMULATORS OF VENO LYMPHATIC CIRCULATION ANDROID TYPE (APPLE) (ABDOMEN, UPPER PART OF THE BODY, CHEST, SHOULDERS ARMS) WE USE - DRAINING DRUGS - VASODILATORS - LIPOLYTIC DRUGS 46 BODY SCULPTING • CONTOURING OF THE ABDOMEN, ARMS, LEGS AND HANDS CAN BE OBTAINED WITH MESOTHERAPY. • THE MEDICINE PRODUCTS USED TO TIGHTEN SAGGING SKIN ARE : – – – – VASODILATORS TROPHIC DRUGS VITAMINS HYALURONIC ACID • OTHER AGENTS CAN BE INJECTED TO REMOVE AREAS OF FAT : – LIPOLYTICS • THE RESULT IS A RESTORATION OF A MORE YOUTHFUL AND ATHLETIC APPEARANCE. 47 MESOLIFT SKIN • PHENOTYPIC SKIN CHANGES ARE CAUSED BY AGEING AND CONDITIONED BY INTRINSIC AND EXTRINSIC FACTORS. INTRINSIC FACTORS (AGE , SEX, OESTROGENC STATE) • HISTOLOGICAL STUDIES CONFIRM THAT THE EPIDERMIS THEN EXPERIENCES SUBSTANTIAL DENSITY LOSS AND ATROPHY. • THE WATER-HOLDING CAPACITY OF THE STRATUM CORNEUM IS REDUCED, RESULTING IN TISSUE DEHYDRATION. EXTRINSIC FACTORS (TEMPERATURE VARIATION, WIND, EXPOSURE TO ABRASIVE PRODUCTS, DRUGS, LIGHT, etc..) • THESE FACTORS DETERMINE THE APPEARANCE OF WRINKLES AND THE LOSS OF SKIN’S TONICITY AND ELASTICITY. 48 MESOLIFT SKIN AGEING EVOLVES IN THREE PHASES : PHASE 1 : THE SKIN STAYS TONIC MODERATE DEHYDRATATION NO WRINKLES WHEN FACE IS AT REST (ONLY APPEAR WHEN SMILING) PHASE 2 : THE SKIN IS WRINKLED VISIBLE DRYNESS MILD TO MODERATE WRINKLES AT REST DERMIC FRACTURE VISIBLE WITH FACIAL EXPRESSION PHASE 3 : SLACK SKIN INTENSE DEHYDRATATION ELASTICITY AND TONE LOSS SKIN TEXTURE DETERIORATES MIDDLE TO SEVERE WRINKLES APPEARING AT REST, NUMEROUS AND DIFFUSED. 49 MESOLIFT SOLUTIONS • THERE ARE MANY “ANTI-AGEING” TREATMENTS. • INDICATIONS WILL DEPEND ON VARIOUS FACTORS SUCH AS THE AREA TO BE TREATED, STAGE OF AGEING AND SKIN TYPE. • MESOLIFT IS PART OF THE OVER ALL MANAGEMENT PROCESS. • THIS TECHNIQUE COMBINED WITH HYALURONIC ACID-BASED SOLUTIONS CAN COMPENSATE POOR-QUALITY OR LOSS OF HYALURONIC ACID. • INJECTED INTO THE DERMAL-EPIDERMAL JUNCTION OR THE SUPERFICIAL DERMIS, EXOGENOUS HYALURONIC ACID RAPIDLY REACHES THE DERMIS. • THIS HAS THE FOLLOWING RESULTS : RECOLONISATION OF THE EXTRACELLULAR MATRIX IMPROVED SKIN HYDRATION AND ELASTICITY DISAPPEARANCE OF FINE WRINKLES RESULTING IN SKIN BEAUTY (MESOGLOW) 50 MESOLIFT HYALURONIC ACID • THE SKIN CONTAINS THE MAIN SUPPLY OF HYALURONIC ACID WHICH IS A KEY COMPONENT OF THE EXTRACELLULAR MATRIX. • ITS HYGROSCOPIC PROPERTIES GIVE IT ITS WATERHOLDING CAPACITY AND GUARANTEE THE HIGH DEGREE OF HYDRATATION REQUIRED BY SKIN TISSUES. • IN EFFECT, HYALURONIC ACID ACTS LIKE A MOLECULAR SPONGE. • DUE TO INTRINSIC AND EXTRINSIC FACTORS, SKIN LOSES ITS HYALURONIC ACID. 51 JUVELIFT : THE NEW HYALURONIC ACID-BASED SOLUTION FOR MESOLIFT 52 JUVELIFT • JUVELIFT (CORNEAL) • IS A SOLUTION OF NON CROSS-LINKED HYALURONIC ACID OF BIOSYNTHETIC ORIGIN. • DESIGNED FOR MESOLIFT TECHNIQUES APPLIED TO THE FACE, NECK, DECOLLETE AND BACK OF THE HANDS. 53 JUVELIFT INJECTION TECHNIQUES JUVELIFT CAN BE INJECTED INTO AREAS OF THE FACE, NECK, DECOLLETE AND HANDS WHOSE SKIN HAS LOST ITS TONICITY AND REVEALS FINE LINES. SEVERAL PUNCTURE TECHNIQUE THIS TECHNIQUE IS POSSIBLE MANUALLY OR WITH AN INJECTION GUN. IT CONSISTS OF MICRO INJECTIONS INTO THE DERMAL-EPIDERMAL JUNCTION OR THE SUPERFICIAL DERMIS OF THE FACE, NECK, DECOLLETE OR THE BACK OF THE HANDS. PATIENTS MUST BE WARNED THAT THE EFFECTS OF “PAPULAR” SERIAL PUNCTURE INJECTIONS MAY STILL BE VISIBLE 2 OR 3 DAYS AFTER THE SESSION, DEPENDING ON SKIN TYPE. LINEAR THREADING OR CROSS-HATCHING TECHNIQUE THIS TECHNIQUE IS MAINLY USED ON LINES IN FRAGILE AREAS OF THE FACE CAUSED BY FACIAL EXPRESSIONS : CROW’S FEET, SMILE LINES ON THE CHEEKS AND ORAL COMMISSURES. IN THIS CASE, JUVELIFT IS INJECTED INTO THE SUPERFICIAL DERMIS USING THE LINEAR THREADING TECHNIQUE (LINEAR INJECTIONS OR VERTICAL INJECTIONS FOLLOWED BY HORIZONTAL ONES : CROSS-HATCHING) 54 JUVELIFT • ADVANTAGES • 13.5 mg/g OF HYALURONIC ACID, I.E. A CONCENTRATION 1,000 TIMES HIGHER THAN THAT OF THE ENDOGENOUS HYALURONIC ACID CONCENTRATION IN THE EPIDERMIS AND 200 TIMES HIGHER THAN THAT IN THE DERMIS. • MOLECULAR WEIGHT OF 2.5.106 Da (the highest on the market) AT LEAST DOUBLE THAT OF THE SKIN (106 Da). • THE CONCENTRATION AND THE HIGH MOLECULAR WEIGHT OF JUVELIFT (CORNEAL) PROVIDE MORE ACTIVE AND LONGER-LASTING HYDRATION TO PREVENT AND COMBAT SKIN AGEING. • SKIN TONICITY IS ENHANCED. 55 JUVELIFT • TOLERANCE : HYALURONIC ACID IS ALREADY USED IN A VARIETY OF THERAPEUTIC INDICATIONS SUCH AS OPTHALMOLOGY, RHEUMATOLOGY AND DENTISTRY. • IN DERMATOLOGY, IT IS USED AS A FILLER FOR SKIN DEPRESSIONS. • JUVELIFT : IS STERILE, NON-PYROGENIC, NON-IRRITATING,NONCYTOTOXIC, FREE OF TISSUE REACTION. HAS BEEN USED IN OTHER INDICATIONS FOR 8 YEARS 56 JUVELIFT TREATMENT • THE CHOICE OF THERAPEUTIC PROTOCOL WILL DEPEND ON THE STAGE OF AGEING. • SEVERAL SESSIONS MAY BE REQUIRED TO ACHIEVE THE DESIRED EFFECT. • INJECTION SCHEDULE FOR EACH INDIVIDUAL PATIENT. • A MINIMUM INTERVAL OF TWO WEEKS SHOULD BE OBSERVED BETWEEN SESSIONS. • THIS TREATMENT MAY BE SUPPLEMENTED BY INJECTION OF WRINKLE FILLERS. 57 REVITACARE BIO-REVITALISATION PRODUCT PRESENTATION • 4 ML : NON RETICULATED HYALURONIC ACID – BIOTECHNOLOGY ( NON ANIMAL) – BIO-COMPATIBLE – BIO-DEGRADABLE • 10 ML : BIOLOGIC STERIL SOLUTION WITH VITAMINS – VITAMINS A, E, C. – VITAMIN D. – VITAMINS B1, B2, B3, B4, B5, B6. 58 REVITACARE BIO-REVITALISATION PROPERTIES • HYALURONIC ACID : – HYDRATATING : SPECIFIC CAPACITY TO CREATE WATER MOLECULE HELPING DERM TO FIRMESS AND ELASTICITY. – RESTRUCTURING : KEY ROLE IN ORGANIZING EXTRA CELLULAR MATRIX. – FIBROLAST STIMULATION : FORERUNNER OF COLLAGEN AND ELASTIN. – ANTI-FREE RADICAL EFFECT : MAIN PROTECTION BY ELIMINATING NOXIOUS SKIN COMPONENTS. • POLYVITAMINS : – A,E,C : ANTI-OXIDIZING ACTION – D : ESSENTIAL FOR CALCIUM SYNTHESIS – VITAMINS B GROUP (B1,B2,B3,B4,B5,B6) : THESE VITAMINS ARE ESSENTIAL FOR A WELL BALANCED SKIN. 59 REVITACARE BIO-REVITALISATION THE BENEFITS OF REVITACARE BIO-REVITALISATION ARE NUMEROUS : • SKIN IS MORE : – – – – – SUPPLE FIRM SMOOTH HEALTHY BRIGHT • BIO-REVITALISATION CAN BE USED COMPLEMENTARY TO WRINKLES FILLING, BOTOX SESSION, AFTER A PEELING TO OPTIMISATE THE RESULTS. • • TECHNIQUES OF USE : SEVERAL TECHNIQUES CAN BE USED, EITHER SEPARATLY OR GENERALLY JOINTLY DURING THE SAME SESSION OF TREATMENT : – THE MULTIPUNCTURE – THE NAPPAGE 60 MESOLIFT RESULTS • YOUR SKIN IS FIRM, SMOOTH AND HEALTHY. • YOU HAVE A YOUNGER GLOW. • YOU LOOK GOOD. 61 MESO BOTOX BOTOX INJECTIONS WITH MESOTHERAPY • THE BOTOX IS DILUTED WITH PHYSIOLOGICAL SERUM (10 CC) OR COMBINED WITH AN ANESTHESIC (9 CC OF SALIN SERUM + 1 CC OF ADRENALISED XYLOCAINE 2 %). • BOTOX DILUTION DEPENDS ON THE AREAS TO BE INJECTED ON THE FACE. • A DETAILED EXAMINATION OF THE PATIENT‘S FACE IS NEEDED. • NOTING AND TRACING FACIAL POINTS, LINES AND WRINKLES (DERMATOLOGICAL PENCIL). • MESOTHERAPY BOTOX INJECTIONS INCLUDE SMALL DERMAL PAPULAS. • INTRADERMAL INJECTIONS ARE REPEATED AND A SMALL AMOUNT OF PRODUCT (MORE OR LESS DILUTED) IS INJECTED ALONG THE LINES TRACED WITH PENCIL. 62 MESO BOTOX • THE PRACTITIONER MUST INJECT THE RIGHT DOSE OF BOTOX TO AVOID A MASK-LIFE EFFECT. • IT IS NECESSARY TO CHECK THE EFFECTS OF BOTOX SESSION AFTER TWO WEEKS. • THE TREATMENT’S ORIGINALITY IS THE SUPERFICIAL ACTION ALONG THE FACIAL MUSCLES. • THESE MUSCLES ARE FINE, TINY AND OFTEN INTRICATELY LINKED. • VIA THESE MORE SUPERFICIAL INJECTIONS, THE THERAPIST ACTS ON THE MUSCLE’S FIBERS TO ACHIEVE AN OVERALL RELAXED EFFECT. • THE FACE LOOKS MORE SERENE. 63 HAIR LOSS MESOTHERAPY • ALOPECIA AFFECTS BOTH MEN AND WOMEN. • THE LOSS OF HAIR RESULTS FROM : – – – – • THE MESOTHERAPY PROTOCOL FOR HAIR GROWTH INVOLVES USE OF A COMBINATION OF PRODUCTS SUCH AS : – – – – – – • POOR SCALP BLOOD FLOW NUTRITIONAL DEFICIENCIES EXCESSIVE ANDROGENS (ANDROGENIC ALOPECIA) MECANICAL ALOPECIA BY TRACTION BIOTIN BEPANTHENE (DEXAPANTHENOL) VITAMIN C MULTI-VITAMINS (NCTF 135) SILICIA VASODILATORS IN SOME COUNTRIES : – – FINASTRIDE (PROPECIA) PLACENTEX 64 HAIR LOSS MESOTHERAPY • 3 OR 4 DRUGS WILL BE MIXED AND THE QUANTITY TO BE INJECTED WILL NOT EXCEED 2.5 CM³. • INJECTIONS ARE PERFORMED AT THE LEVEL OF THE SCALP WITH A 2.5 CM³ SYRINGE USING A 4 MM NEEDLE. • THE TECHNIQUE OFTEN ASSOCIATES DEEP INTRADERMAL IDP IN CONTINOUS INJECTION WITH SUPERFICIAL INTRADERMALS, MULTIPRICKING. • FOR ACUTE HAIR LOSS : – ONE SESSION EVERY WEEK DURING THE FIRST MONTH – ONE SESSION EVERY TWO WEEKS DURING THE TWO MONTHS AFTER – ONCE A MONTH , REACHING A TOTAL OF 12 TO 15 SESSIONS. • FOR CHRONIC HAIR LOSS : – EVERY 3 WEEKS. 65 SCARS ON THE MORPHOLOGIC LEVEL, 3 TYPES OF SCARS CAN BE DIFFERENTIATED : → KELOID SCARS : • CLASSICALY, DERMATOLOGISTS PROPOSE DOING CORTICOID INFILTRATIONS. • IN MESOTHERAPY, THE PROCEDURE USED FOR INJECTION WILL CONSIST OF : – A DILUTED CORTICOID – WITH A 4 MM NEEDLE VERY USEFUL FOR THESE SCARS. → HYPERTROPHIC SCARS : • FOR THIS TYPE OF SCAR, GENERALLY FIBROUS, WE SUGGEST • USING : – A DILUTED ANTI-INFLAMMATORY ASSOCIATED WITH AN ANTIEDEMA – WITH A 4 MM NEEDLE AT THE LEVEL OF THE SCAR, EVERY 2 OR 3 MM. – SESSIONS WILL BE PERFORMED EVERY 2 OR 3 WEEKS. 66 SCARS → FLAT SCARS : • FOR THE NON AESTHETIC FLAT SCARS, WE SUGGEST : – A NAPPAGE TECHNIQUE IN SUPERFICIAL INTRADERMAL – THE MIXTURE GENERALLY USED ASSOCIATE PROCAIN AND VITAMINS AND VASODILATORS. OTHER MEDICINE PRODUCTS • PLACENTEX (ITALY) HAS SHOWN ITS QUALITY IN BLIND TEST STUDIES FOR HEALING PHENOMENA. • IN BRAZIL, PRACTITIONNERS ARE USING “LISADOS”, “COLLAGEN”, “ELASTIN” OR “PLACENTA”. • IN THE CASE OF DARK SCARS, ASCORBIC ACID (VITAMIN C) HAS PROVED HELPFUL TO LIGHTEN THE SCAR. 67