The term mesotherapy was originally coined by journalists who attended a lecture by the French-born Dr. Michael Pistor. They thought he was referring to the mesoderm, which was one of three integral parts of the embryonic layers, instead of injections into the dermis, which is the middle layer of the skin. Initially, in 1958, Dr. Pistor intended its use only for medical and musculoskeletal disorders, but nowadays, it is being used extensively for cosmetic purposes. The theory behind the functioning of mesotherapy in dermal treatments is simple: the stratum corneum of the skin forms a barrier to most large molecules, and this barrier is disrupted to allow the deposition of enough amounts of pharmaceuticals for their therapeutic effects. Numerous studies in support of this form of therapy indicate that molecules that were deposited in the epithelial layer or intradermal layer can still be found after eight hours, as compared to one hour for subcutaneous injections. The fact that it is capable of achieving such a prolonged exposure further enhances the effects on any target lesions. The skin is restored to a youthful and healthy appearance and can even be maintained for a period after the treatment procedure. The products that are injected into the skin increases its hydration and can brighten the skin. The end result is a firm, elastic skin with an even skin tone. The products are also usually absorbable and biocompatible. Currently, mesotherapy can be used for skin rejuvenation and to target common skin conditions, such as rosacea, acne, localized adipocytes, stretch marks, cellulite, and hair loss. This article is written to guide and highlight the application of mesotherapy in a case study of a patient with dehydrated skin below the eyes and mid-cheek area.
Approach to treatment
Mesotherapy uses a combination of various homeopathic and pharmaceutical medication, plant extracts, and vitamins. These are injected into the mesoderm layer in the hopes that it will target the adipose fat cells, dermal vasculature, and connective tissue septae. It typically consists of four injection sessions that are interspersed weekly or biweekly. Like many other treatment protocols, the mesotherapy treatment regime depends on how determined the patient is for skin rejuvenation because the sessions can only be carried out based on their availability. An mesogun is used to consistently deliver the products into the desired depth and to ensure a satisfactory outcome.
For every session, the same procedure is followed strictly to make sure that the results are uniform. The products used are categorized to ensure that they act synergistically to treat different aspects of the skin. Skin hydration is vital in any regime; therefore, it has been carefully curated for 30% of it to be medium molecular weight hyaluronic acid (non-crosslinked hyaluronic acid molecular weight 2%); 30% to be a nutritive complex (hyaluronic acid, amino acids, vitamins, nucleic acids, co-enzymes, and reducing agents) for polyrevitalization; another 32% to be a mesolift cocktail (hyaluronic acid, multivitamins BCAE, sodium DNA, organic silicium, and DMAE); and the remaining 8% to be procaine (procaine 2% 20mg/ml). The cocktail that is deployed here contains centella asiatica as one of the main ingredients, and it has skin reparative properties and dermal regenerative substances, such as dexpanthenol, elastin, and organic silicium, that helps to improve collagen fibers. However, please note that the components listed down here should not be unchanging, because you are encouraged to meet the individualized demands of your patient. For example, you can tailor your treatment plan to the patient’s age by switching the mesolift cocktail for a regeneration cocktail that is more suitable for skin that is severely affected by ageing. For patients in the younger age group, consider changing to the radiance cocktail to effectively help them achieve a glowing skin appearance.
Prior to initiating treatment, you must examine the patient’s past medical history thoroughly. The main purpose is to exclude patients with relative contraindications, such as those with a history of diabetes mellitus type 1 or type 2; autoimmune skin conditions (e.g. eczema, psoriasis); and patients that have body dysmorphic syndrome. Counsel the patient regarding the treatment results, length of procedure, and the maintenance regime that follows. Caution them about the potential cost and commitment needed in the long-term. For documentation, take photographs of the treatment area before treatment initiation so that they can be used as a baseline. It is also recommended for you to continue recording the progress of their treatment during each session.
The mesogun is the tool of choice when it comes to injecting the products needed for the desired effect in mesotherapy. Many patients find that the self-injecting mesogun is less distressing than manual injections. This is further supported by Duncan and Chubaty, who reported that using the mesogun dramatically reduced pain perception and increased the overall experience of patients’. To ensure that there is an even distribution, you should configure the mesogun to inject at a depth of 1 mm and at a rate of 300 injections per minute.
This is a case of a 37-year-old female patient who had a history of botulinum toxin type A treatment for dynamic facial lines, hyaluronic acid (HA) fillers for volume restoration, and a hydrating HA product. The patient had felt the positive effects from the hydrating HA product was too transient, and this frequently caused her skin to be dry by the end of the day. She appeared to be a good candidate for mesotherapy for the area of skin that was affected. She was subsequently consulted for the procedure to be done. She agreed for four sessions that were required for the entire face, as per protocol.
The patient’s skin was sanitized with chlorhexidine solution, and the mesogun was loaded with 5ml of the protocol mixture. A series of injections was done to achieve a full facial treatment. It is common to have excess products that remain on the skin. They should be of little cause for concern since they will be absorbed if left on the skin for a sufficient amount of time. The patient had minimal complaints except for the treatment of the area immediately superior to the lips, where she found the treatment slightly distressing.
The injection technique
The injection technique used is known as “nappage.” El-Domyati and colleagues illustrated that this technique is a series of fast and linear injections that occur at the superficial or mid dermis depth (1–4mm). The aliquots deposited are 0.1ml and are separated by a distance of a few millimeters. Many undesirable effects are technique-related; therefore, it is important to know the origin of the drugs used, the amount, the number of sessions carried out, and the interval between said sessions Also, avoid using more than four substances at the same time.
Post-treatment care should be treated with equal importance. The patient was advised to apply a broad-spectrum sunscreen with an SPF rating of 50 and a recovery cream. Common complications from injection-related procedures, such as hematomas and bruising, were not observed. There were also no reported incidences of mechanical nerve lesion, cutaneous necrosis, or infection. The patient was also instructed to not wash her face for several hours after treatment.
The treatment then went on for four session that were similar in preparation, injection technique, dosage, and post-treatment care. Each session was separated by a two-week interval, with photographs taken before each session for comparison.
Feedback and Outcome
The patient was satisfied with the results, as she claims that her skin felt more hydrated than before. The greatest improvements were noted after the third and fourth session, as her skin was seen to look fresher and better rested. Her occupational stress was the main cause of her dehydrated-looking skin prior to treatment. Now, she is able to have radiant skin that can last throughout the evening. She mentioned that this outcome far exceeded her expectations.
She was advised to undergo maintenance treatment to prolong the effects of treatment. The protocol for hydration is a repeat of treatment after two to three months. The skin is reviewed after two months, and if deemed necessary, the patient will be booked for the following month or earlier.
Mesotherapy is a novel non-invasive procedure that can be undertaken to deliver nutrients and antioxidants for healthier skin and to address common health concerns, such as weight loss, cellulite, and hair growth. Most people will have no contraindications to mesotherapy, but their goals and expectations should be kept at a reasonable level; after all, the procedure does not perform miracles. At best, with expert hands and the right patient, mesotherapy can assist in achieving results but cannot guarantee them. There are currently still no double-blind placebo-controlled studies to support its use. The benefits from mesotherapy, for the most part, is anecdotal. However, after 50 years of history, authorities in France, Italy, and many other European countries have declared public support for its efficacy. Some medical professionals report profound improvements in waist loss that range from six to 13 inches. It is in the best interest of the aesthetic field to keep expectations modest despite these reports, as there is a huge variability in results seen between different treatment facilities capable of performing mesotherapy. The race between researchers to produce the necessary study and data to support the use of mesotherapy has so far contributed much to the advancement in this treatment modality. It is only a matter of time that the future of mesotherapy is laid in the foundation of skin care alongside staple skin rejuvenation techniques, such as chemexfoliation.