Mesotherapy for facial skin Mesotherapy for facial skin rejuvenation: A clinical, rejuvenation: A clinical, histologic and electron-histologic and electron-microscopic evaluation.microscopic evaluation.

Amin S. et al.Amin S. et al.

Dermatol Surg 2006; 32: 1467-Dermatol Surg 2006; 32: 1467-14721472

IntroductionIntroduction

described by Michel Pistor in 1952described by Michel Pistor in 1952consists of the injection of hormones, consists of the injection of hormones,

enzymes, nutrients, pharmaceuticals, enzymes, nutrients, pharmaceuticals, detergents, and other substances into the detergents, and other substances into the subcutaneous layer of the skin.subcutaneous layer of the skin.

originally developed to treat vascular and originally developed to treat vascular and lymphatic disorders.lymphatic disorders.

is an intriguing yet poorly studied method for:is an intriguing yet poorly studied method for:-body contouring-body contouring-cellulite treatment-cellulite treatment-lipolysis-lipolysis

few clinical studies have been published few clinical studies have been published showing the mechanism of action and active showing the mechanism of action and active ingredients of mesotherapy for lipolysis.ingredients of mesotherapy for lipolysis.

concern also raised for the potential adverse concern also raised for the potential adverse effectseffects

Although synonymous with injection induced Although synonymous with injection induced lipolysis, it has also been used to treat a variety lipolysis, it has also been used to treat a variety of rheumatologic and dermatologic disorders.of rheumatologic and dermatologic disorders.

skin rejuvenation of the face is one of the latest skin rejuvenation of the face is one of the latest applicationsapplications-there are virtually no scientific peer-reviewed -there are virtually no scientific peer-reviewed publicationspublications-rhytid reduction, increased elasticity, and -rhytid reduction, increased elasticity, and improved pigmentation have been anecdoctally improved pigmentation have been anecdoctally suggested, unthough umproven.suggested, unthough umproven.

ObjectiveObjective

first clinical evaluation on the effect of first clinical evaluation on the effect of mesotherapy for facial skin rejuvenation.mesotherapy for facial skin rejuvenation.

evaluates clinical, histologic, and evaluates clinical, histologic, and ultrastructural changes. Adverse effects ultrastructural changes. Adverse effects also recordedalso recorded

MethodsMethods

10 subjects: exclusion: pregnancy, retinoid use, 10 subjects: exclusion: pregnancy, retinoid use, lasers in the previous 6 months…keloid. (Table lasers in the previous 6 months…keloid. (Table 1 ). 4 treatments in a 6 month interval.1 ). 4 treatments in a 6 month interval.

LMX (Ferndale Laboratories) topical anesthesia LMX (Ferndale Laboratories) topical anesthesia under occlusion one hour before procedure.under occlusion one hour before procedure.

injection of a 9:1 suspension in hyaluronic acid injection of a 9:1 suspension in hyaluronic acid gel (Hopewell pharmacy). Mixture immediately gel (Hopewell pharmacy). Mixture immediately before injection.before injection. (Multivitamin Mixture, not (Multivitamin Mixture, not specified)specified)

injections with needles with adjustable hubs injections with needles with adjustable hubs (figure 1), 1.5 mm long so that perpendicular (figure 1), 1.5 mm long so that perpendicular injection feasible.injection feasible.

0.01ml injected at 1cm intervals for a total of 0.01ml injected at 1cm intervals for a total of 200-250 injections (2-2.5ml)(figure 2)200-250 injections (2-2.5ml)(figure 2)

ice packs applied after 5-10 min and observation ice packs applied after 5-10 min and observation for 30 minutes for adverse side effects.for 30 minutes for adverse side effects.

surveys performed monthlysurveys performed monthly

skin biopsies before first RX (angle of right mandible) and skin biopsies before first RX (angle of right mandible) and biopsy done 6 months later at 1cm:biopsy done 6 months later at 1cm: -HE … stain-HE … stain-electron microscopy evaluation-electron microscopy evaluation-blinded dermatopathologist:-blinded dermatopathologist:-epidermal thickness-epidermal thickness-vessel size and density-vessel size and density-solar elastosis-solar elastosis-elastin content-elastin content-collagen fibre diameter by equal magnification electron -collagen fibre diameter by equal magnification electron microscope photographsmicroscope photographs-presence of sclerosis-presence of sclerosis-overall appearance-overall appearance

photography (6.1 Mpixels) done before photography (6.1 Mpixels) done before treatment and 6 months after.treatment and 6 months after.

-evaluation by blinded physician using-evaluation by blinded physician using-temporal sequencing (Table 2): max -temporal sequencing (Table 2): max

20, min –20.20, min –20.-individual parameters (0-3 points) -individual parameters (0-3 points)

(no statictical analysis because only 10 patients)(no statictical analysis because only 10 patients)-dyspigmentation-dyspigmentation-rhytid level-rhytid level-erythema-erythema

ResultsResults

No significant improvement on the photograph No significant improvement on the photograph assessment (figure 4) (Table 3) (Table 4)assessment (figure 4) (Table 3) (Table 4)

Microscopic evaluation showed no significant Microscopic evaluation showed no significant changes in epidermal thickness, vessel size and changes in epidermal thickness, vessel size and density, solar elastosis, elastin content, mucin density, solar elastosis, elastin content, mucin content, dermal thickness, collagen fibre content, dermal thickness, collagen fibre thickness, presence of sclerosis, and overall thickness, presence of sclerosis, and overall appearance.appearance.

Electron microscopy showed a diminished Electron microscopy showed a diminished diameter of collagen fibres (Table 5)diameter of collagen fibres (Table 5)

Several adverse effects noted, none Several adverse effects noted, none serious (Table 6).serious (Table 6).

4 out of 10 patients described increase 4 out of 10 patients described increase smoothness to the skin and increased smoothness to the skin and increased tone in the skin, which did not persist tone in the skin, which did not persist beyond one week after each session.beyond one week after each session.

DiscussionDiscussion

temporal assessment: value close to 0 temporal assessment: value close to 0 implies no effect. Slightly negative values implies no effect. Slightly negative values could be explained by normal aging.could be explained by normal aging.

the transient effect on skin smoothness the transient effect on skin smoothness reported in 4/10 patients could be reported in 4/10 patients could be explained by a transient oedematous explained by a transient oedematous effect.effect.

decrease in the diameter of collagen fibers decrease in the diameter of collagen fibers can be explained by synthesis of new can be explained by synthesis of new collagen with follows inflammation or collagen with follows inflammation or thermal injury and is frequently associated thermal injury and is frequently associated with the presence of a repair zone.with the presence of a repair zone.

QuestionsQuestions

-evaluation at 1 year?-evaluation at 1 year?

-more treatments?-more treatments?

-control group?-control group?

-more effective than other non ablative -more effective than other non ablative treatments?treatments?

  

Due to the popularity of mesotherapy, future Due to the popularity of mesotherapy, future studies will be required.studies will be required.