mesotherapy

mesotherapy

Mesotherapy is performed in sessions. The goals of the sessions are different from each other. Performing these sessions regularly will also increase the targeted success.

Mesotherapy is a method developed by French physician Michel Pistor that aims to provide direct targeted treatment with low doses of drugs that can be injected under the skin. The word mesotherapy was defined by Pistor in 1958 and the name was given because the products of the mesoderm, which are the 3 embryonal layers that make up the fetus, are the target of this treatment. It consists of injections at depths not exceeding 10 mm.

When mesotherapy first appeared, its aim was to provide more effective pain control and with fewer side effects in cases such as tendon diseases that cause regional pain, rheumatic joint diseases, lymphedema (insufficiency in the lymph system), venous (veins) insufficiency and cancer. However, over time, various new application areas for mesotherapy have emerged and this microinjection has become popular. The two most important of these are as follows:

1. Cosmetic purposes in mesotherapy:

• Wrinkled, worn, thin, dry skin
• Tired face appearance
• Treatment of sun damage to the skin
• Increasing the adhesion rate of the hair patch by supporting the blood supply to the scalp before hair transplantation.
• Stopping hair loss and ensuring the thickening of new hair follicles
• Treatment of fine wrinkles
• Treatment of excessive sweating
• cellulite treatment
• Stains due to veins

2. Pain control with mesotherapy:

Injections are made directly to the painful points in order to provide more effective treatment while reducing the dose of painkillers used in the chronic diseases that cause the pain I have listed above. On the other hand, injections are made to some trigger points for pains that make life tiring, such as migraines and menstrual pains .

Although not included in the definition of mesotherapy, the basic working principle of acupuncture, botulinum toxin type A, PRP and stem cell injections is the same as mesotherapy.

Various chemical cocktails are used in mesotherapy applications. In the past, we used to prepare these cocktails by combining individual drugs, but now ready-made solutions with more precisely adjusted drug doses are preferred.

The main drug groups used in mesotherapy are drugs that provide pain relief or regional anesthesia (such as li-docaine, procaine), amino acids (such as L-carnitine, L-arginine), enzymes (hyaluronidase, collagenase), vitamins, and various other drugs (phosphatidylcholine, isoproterenol). , glutathione, ginkgo biloba, melilotus, buflomedil etc.) are various trace elements.

Image Note: Mesotherapy includes regional low-dose injection treatments for skin, muscles, ligaments and joints.

There is no prospective controlled study showing that the use of mesotherapy for cosmetic purposes is truly effective. However, patients clearly reveal the change in their skin structure.

In mesotherapy, the aim is to first increase blood circulation in the area that causes regional complaints through subcutaneous or intramuscular injection, and then create a healthier tissue with area-structuring substances. However, there is no study based on numerical data with a control group that shows ideal tension in the facial skin, increase in skin thickness and similar changes. However, almost all of my patients describe a vibrant skin color and a clear improvement in skin moisture and elasticity. These are the changes that I can clearly observe during follow-up examinations. However, the application requires repeating at certain intervals.

Clearer observations can emerge when mesotherapy is applied for hair and scalp health. For example, there may be an increase in hair diameter, an increase in hair root resistance and a decrease in breakage.

Mesotherapy is performed in sessions. The goals of the sessions are different from each other. Performing these sessions regularly will also increase the targeted success.

In mesotherapy sessions, the aim is to increase the blood flow to the target tissue in the initial stages and to ensure better penetration of the therapeutic drugs to be administered afterwards. However, the increase in blood flow to the tissue itself has the chance to reduce pain by increasing the nutrition of the tissue, as in the muscles. Again, shedding can be reduced to some extent by eliminating the malnutrition in the tissue, which is among the basic mechanisms of hair loss.

When mesotherapy is applied to a large area, especially, using specialized gun systems to distribute the same amount (homogeneous) to every point will shorten the time and limit the energy spent.

Mesotherapy sessions can last between 30 minutes and 1 hour on average. The technique used here is important. Injections are applied with the injection technique called nappage. Napaj technique was developed by French physician Dr. It is a multiple point injection technique defined by Dalloz Bourguigon.

Later, automatic mesotherapy guns were developed to make these injections faster and more regularly and to ensure the same depth. In these guns, which mostly work with the air injection system, the injection frequency and depth can be easily adjusted.

Image Note: Microneedle roller application called dermal roller.

The main purpose of the method known as the dry needle technique is to initiate an inflammatory response in response to the trauma caused by the needle inserted into the tissue and subsequently trigger the production of new connective tissue.

The basic building block of the intercellular substance in the tissues of our body is the connective tissue protein called collagen (collagen, collagen, collagen) . Various changes occur in the structure of collagen and the sequence of its molecules in connective tissue diseases, aging, and pregnancy. One of the main goals of mesotherapy is to affect this arrangement, ensuring a more homogeneous and regular arrangement of collagen and stimulating the production of new collagen. New collagen production is one of the important late stages of wound healing. In order to create this process artificially, various studies have been conducted on the hypothesis that mechanical stimulation of the tissue with a needle may be effective. In fact, another result of the same mechanical stimulation is that the trigger points that cause pain in the body are resolved by a similar mechanism. Most of the studies have focused on diseases that may have a rheumatic background, such as myofascial pain (1, 2).

Acupuncture treatment is a method based on stimulation of the skin's nerve distribution foci with a needle, which has been used for centuries by Chinese medicine.

The idea that treatments based on needle insertion into the skin can be effective has led to the development of various treatment attempts over the centuries. Although acupuncture is one of these methods, it is not considered in the mesotherapy class. Acupuncture targets instant stimulation of special points in the sensory distribution areas called dermatome, located on the skin, with thin needles. The connection of these foci in the skin with the sensory nerves of the internal organs through nerve pathways has been defined anatomically. The aim of the treatment is to stimulate these foci and stimulate physiological improvement in the organ that is the source of pain or complaint. A significant collagen synthesis or connective tissue formation is not targeted. Therefore, its effectiveness is different from mesotherapy. For example, while acupuncture treatment for weight loss is effective through the appetite mechanism, mesotherapy lipolysis, which provides regional slimming, only targets the thinning of fat tissue.

Combing the skin with needle rollers called rollers can provide similar results to the dry needle technique. Although it is thought that chemical substances called mediators and growth factors occurring under the skin contribute to skin regeneration, there are not enough studies on this subject.

Similar to the dry needle technique, holes are made in the dermis layer of the skin, especially in the dermis, with micron-sized needles, aiming to stimulate the formation of dermal connective tissue, that is, collagen, and increase blood circulation. Although there are claims that it is effective in hair loss, there are not enough studies with comparative statistical results (3). I think it can be tried in sessions due to its potential to increase blood flow to the face and stimulate the formation of connective tissue (i.e. fibrosis).

Image Note: Mesoretapi gun examples

On the other hand, dermal roller application can also be used to deliver certain chemicals from the skin to deep tissues over a wide surface (4). For example, absorption of platelet-poor plasma (PPP) and thrombin, which are blood products, can be possible by applying them to the surface after dermal roles, instead of injecting them through the skin.

Before mesotherapy application, I want my patients to report any past or ongoing important diseases (liver, kidney, diabetes, heart disease, etc.), any history of allergies or regular medication use.

The application to be made in mesotherapy can basically be of three main types. While depths up to 1 mm are considered as epidermic injections (intraepidermic, that is, made to the epidermis layer), injections between 1-4 mm are considered intradermic injections . Injections between 4-10 mm are generally intra-joint and muscle and are called hypodermic injections. It is not recommended to go deeper than 10 mm for injections. More than 5 varieties are not recommended in the cocktail containing the substances to be injected. We also recommend that blood thinners be stopped at least 4-5 days in advance. For those containing blood thinners of the rivaroxaban group, 1-2 days of drug withdrawal is sufficient.

Mesotherapy in the treatment of cellulite aims to provide homogeneous slimming, but it may not be equally effective in every patient and in every part of the body.

The condition, which is known as cellulite but should actually be called fat dystrophy (lipodystrophy), is basically caused by regional bulging of the fat tissue due to the length of the connective tissue compartments (septum) connecting the skin to the underlying muscle tissues being short compared to the thickness of the fat tissue. The main goal of treatment is to thin the fat tissue and disconnect the septums.

Mesotherapy provides a very effective slimming effect in the treatment of cellulite, especially in the early stages, that is, the cellulite that occurs when you squeeze it in your hand while standing (stage 1) and the cellulite that occurs only when standing (stage 2). This application is called mesotherapy lipolysis. When the order and number of sessions are increased, it may also be beneficial for cellulite that occurs while lying down (stage 3).

The basic treatment of cellulite is surgery and this issue is explained in detail in the liposuction section. On the other hand, mesotherapy lipolysis can also provide effective treatment for surface irregularities that may occur after liposuction.

There are various basic rules in mesotherapy. If these are followed, we will stay within safety limits.

The founder of mesotherapy, Dr. Pistor mentions three main basic rules: “Apply little, rarely and in the right spot.” The drugs used in mesotherapy are administered in low doses. Sessions are once a week. After 4-6 sessions, two sessions can be performed every 15 days and then once a month if desired. Again, injections should be applied to the ideal point that causes complaints. Drug doses are much lower than normal and are less likely to cause side effects.

Mesotherapy must be applied under aseptic conditions, that is, with complete surgical cleanliness. Otherwise, serious infections may occur in the subcutaneous soft tissue. Therefore, I recommend that our patients avoid practices that are called under-the-counter practices.

Apart from this, possible side effects are blood accumulation under the skin (hematoma) with repeated sessions, drug allergy (this is a possibility in every session, the fact that an allergy to the drug has not developed before does not mean that it will not develop again) and facial and upper body redness (flushing) due to vasodilator drugs. It is ideal to have equipment suitable for at least adrenaline, antihistamine medications and respiratory support against possible side effects in the clinic where the application is performed.

Resources:

1. Liu L, Huang QM, Liu QG, Thitham N, Li LH, Ma YT, Zhao JM. Evidence for Dry Needling in the Management of Myofascial Trigger Points Associated With Low Back Pain: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil. 2017 Jul 8.
2. Perreault T, Dunning J, Butts R. The local twitch response during trigger point dry needling: Is it necessary for successful outcomes? J Bodyw Mov Ther. 2017 Oct;21(4):940-947
3. Baris R, Kankaya Y, Ozer K, Kocer RG, Bektas CI, Karatas A, Kocer U, Koca G, Astarci HM. The effect of microneedling with a roller device on the viability of random skin flaps in rats. Plast Reconstr Surg. 2013 May;131(5):1024-34.
4. Kim HM, Lim YY, An JH, Kim MN, Kim BJ. Transdermal drug delivery using disc microneedle rollers in a hairless rat model. IntJ Dermatol. 2012 Jul;51(7):859-63.