Mesotherapy: mechanism of action, methodology, indications and contraindications

Mesotherapy is an injection of biologically active substances into the dermis. Multiple microinjections are performed locally into the problem area at the border of the papillary and reticular layers of the dermis. This technique has a large number of indications and options for use.

Indications for mesotherapy

The main indications for mesotherapy are the following:

• restoration of lost tone and elasticity of the skin;
• correction of the face oval, solution to the problem of "double chin".
• evening out and improving complexion (in cases of hyperpigmentation of various origins, “sallow” complexion in smokers and people living in regions with unfavorable environmental conditions);
• prevention of premature skin aging.

In addition, this method can be used to normalize the activity of the sebaceous glands and reduce skin porosity, restore normal skin hydration, correct hypertrichosis, prevent the appearance and elimination of telangiectasias, xanthelasma, and also as part of the complex treatment of hypertrophic scars, acne, rosacea, multiple warts and fibromas (papillomas).

Contraindications to mesotherapy

Mesotherapy is contraindicated in cases of blood clotting disorders (primarily hemophilia), pregnancy and lactation, hypertension stage II-III. Intradermal injections should not be performed in cases of infectious skin diseases such as herpes infection, pyoderma, tuberculosis, etc. Such a small number of contraindications is due to the fact that mesotherapy is a method that allows taking into account the individual characteristics of each patient, the presence of any diseases or allergic reactions, and selecting the drugs that are right for him. In addition, during the treatment, it is possible to take into account the changes that arise or the slow dynamics of the process and change the composition of the injected cocktails or the technique of drug administration.

Techniques for performing mesotherapy

Classical injections, nappage technique, retrograde injections, and infiltration are used.

Classic injections are a method of administration that ensures maximum efficiency of the procedure and the longest deposition of drugs. The depth of needle insertion when injecting drugs into the skin of the face should be 1-2 mm, into the eyelid area, on the neck, in the décolleté area - no more than 1 mm. The distance between the injection points is from 0.5 to 1 cm. The amount of drug injected into each point is from 0.01 to 0.03 ml. The angle of injection is from 45 to 60°.

Nappage is another option for administering drugs during mesotherapy. In this case, injections are made at a minimum distance from each other (2-3 mm), quite superficially and quickly. Depending on the depth of administration, superficial, median and deep nappage are distinguished. In this case, the maximum involvement and activation of the receptor apparatus of the skin occurs, the skin is minimally injured, but a significant disadvantage of this method is the large loss of the administered drugs (up to 50%).

Retrograde injections are the introduction of the drug as it is excreted. In this case, the needle is inserted parallel to the skin. This method produces controlled destruction of wrinkles and "reinforcement".

Infiltration is the introduction of drugs to a depth of more than 4 mm. As a rule, this increases the volume of drugs administered to 0.1 ml. The degree of drug deposition is significantly reduced, they enter the bloodstream faster. Infiltration is used on the skin of the face to correct the oval of the face, "double chin". Injections can be made with a regular syringe manually and using special devices that facilitate the rapid introduction of funds into a large number of points at the same time (injectors, guns). For mesotherapy, various types of injectors can be used - "DHN", "Pistor", etc. The choice of the method of administration depends on the anatomical location, indications and injection technique. When performing the mesolifting procedure, a combination of hardware and manual methods is used. When acting on the skin in the area of the lower eyelids, neck, as well as during controlled destruction of wrinkles, manual methods are used. In this case, syringes with 30G or 32G needles from 4 to 13 mm long are used. You can also use the SIT needle (a needle located in the center of a cone-shaped sleeve - a stop). It allows you to perform the most comfortable procedure for the patient with minimal pain and trauma. Classic injections can be performed both manually and using a gun. Using an injector is most convenient when performing nappage to ensure maximum speed and painlessness of the procedure.

Both traditional medications (anesthetics, vasodilators, lymphotonics and venotonics, vitamins and microelements, enzymes, anti-inflammatory and antibacterial drugs, antiandrogens, etc.) and complex homeopathic and antihomotoxic drugs are administered intradermally. Considering the fact that drugs administered to the upper third of the dermis by multiple microinjections are deposited and remain in the injection area for 6 to 10 days, the recommended frequency of mesotherapy sessions is once every 7-10 days. If prolonged-action drugs are used, it is possible to take a longer break between sessions (up to 2-3 weeks). If homeopathic drugs are used, the recommended frequency of sessions is three times a week.

Mesotherapy is prescribed to prevent premature skin aging in patients starting from 26 years of age. At this age, mesotherapy is especially relevant for people with dry and dehydrated skin. As is known, the levels of hyaluronic acid and chondroitin sulfate are the determining factors for maintaining the skin's water balance and creating favorable conditions for the synthesis and distribution of collagen and elastin in the intercellular matrix. With age, the amount of hyaluronic acid decreases significantly, which is one of the reasons for the appearance of signs of skin aging. At the same time, in some patients, an insufficient amount of hyaluronic acid for metabolic processes is detected already at a young age and should be replenished as soon as possible. For this purpose, it is recommended to administer stabilized hyaluronic acid preparations with prolonged action once every 2 months. A good effect is also achieved by combining these injections with the introduction of vitamins and microelements. Injections of hyaluronic acid (IAL-SYSTEM, Restylane vital or AcHyal) are optimally performed after anesthesia using occlusion of Emla cream in the technique of classical injections. Moreover, Restylane vital is recommended to be injected at a deeper level, without forming papules. This drug, unlike IAL-SYSTEM and AcHyal, is not injected into the periorbital area, but it is excellent for strengthening the contours, oval of the face and creates a longer-lasting hydroreserve. AcHyal vitamin cocktails can be injected using the technique of median or superficial nappage and separate classical injections to ensure full deposition of the drug.

In younger people (18-20 years old), intradermal injections are used to solve seborrhea problems with a tendency to acne formation. For this purpose, various microelements (Zn, Co, Si, Se) and vitamins (A, E, C, B) are administered, as well as some complex preparations that regulate the activity of the sebaceous glands. The recommended frequency of sessions is once a month; women are recommended to do them in the middle of the menstrual cycle. Technique - median or deep nappage, classic injections.

In case of multiple vulgar and flat warts, as well as recurrent herpes simplex (it is necessary to use ribomunil in the inter-relapse period - a drug that stimulates both cellular and humoral immunity. Bleomycin and cycloferon are used to treat warts.

From the age of 28-30, as a rule, the first signs of skin aging in the periorbital area begin to appear, the first manifestations of gravitational ptosis of the soft tissues of the face and neck are possible (deepening of the nasolabial folds, the appearance of excess skin in the chin area). In this case, alternating the introduction of embryonic extracts (mesenchyme or embryoblast), common in European countries (4-5 sessions once every 7-10 days), with the introduction of stabilized hyaluronic acid (IAL-SYSTEM or AcHyal 2-3 sessions once every two weeks or Restylane vital 2-3 sessions once a month) is quite effective. In the future, it is recommended to carry out maintenance procedures once every two to three months (one procedure using hyaluronic acid, and a week later - one procedure with embryonic extracts or vitamins and microelements). After 35-40 years, the course can be increased to 6-10 sessions using embryonic extracts (once a week) and up to 3-4 sessions with IAL-SYSTEM or AcHyal, with the interval between procedures preferably being reduced to 10 days. Maintenance procedures should be done once a month. Homeopathic and antihomotoxic drugs can be used, for example, from the German company "Heel". In this case, the course will consist of 10-15 procedures, which are carried out at shorter intervals (once every three days).

Mesotherapy can be performed in combination with various hardware procedures. In this case, they are performed before intradermal injections (on the same day or the day before). After mesotherapy, it is undesirable to use any procedures with a lymphatic drainage effect (for example, microcurrent therapy) for 3-4 days to avoid reducing the deposition period of the injected drugs. Good results are also obtained by using mesotherapy in the pre- and postoperative period during plastic surgery, chemical and laser resurfacing.

Side effects of mesotherapy

Side effects include pain during injections, erythema, and hemorrhagic spots.

Pain during the procedure may vary among patients. The degree of pain depends on the individual pain threshold, the state of the nervous system at the time of the procedure, as well as the injection technique and drugs administered. To reduce pain, you can use a cream with an anesthetic (for example, Emla), which is applied to the skin in a thin layer 15-20 minutes before the procedure.

Short-term erythema (about 30-60 min) is a natural consequence of the activation of blood circulation and may be more pronounced after the introduction of vasodilators and vitamins. It should not cause any concern. If erythema after a mesotherapy session persists for a long time, then it is necessary to consider changing the composition of the administered cocktails and the advisability of using this method in this patient. It is also necessary to be wary of the possibility of allergic reactions that begin with erythema and conduct appropriate differential diagnostics, and, if necessary, desensitizing therapy.

Hemorrhagic spots (petechiae and ecchymoses) may appear in patients with decreased blood clotting or with impaired elasticity of the capillary wall. There is also a fairly high risk of their appearance when using the technique of controlled destruction of wrinkles or with deep insertion of the needle (deep nappage, infiltration). Any procedures or drugs for their resorption should be applied locally, in the area of the hemorrhagic spot.

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