Microsoft word - frequently asked questions on mesotherap1-ii.docx

Frequently Asked Questions on Mesotherapy What is the di fference between advanced aesthetic Mesotherapy & traditional Mesotherapy? The traditional Mesotherapy technique invented by Dr. Pistor in the 1950’s uses drugs and the skin as a reservoir for a slow release of those drugs in the surrounding tissues. It is a very intelligent, useful and efficient alternative to other classical means of delivery of the drugs into the organism (intramuscular injections and oral intake). The diffusion of comparatively small amounts of a drug into the tissue closest to the pathology spot allows for greater efficiency with low side effects. With this technique, injections are applied in the superficial upper layers of the skin (epidermis and mainly superficial dermis), sometimes reticular deep dermis but never in the hypodermis. Quantities injected per point of injection are limited to 0,01 to 0,05 ml max. Distances between two points of injections are in relation with the depth of injection which varies from a few millimeters in the epidermis to 1-2 or even 3 cm into the dermis. The technique used in Aesthet ic Mesotherapy sometimes also consists of injecting drugs but mostly deals with the injection of sterile injectable cosmetics and/or nutriments. The amounts injected are related to the desired direct, precise & immediate local effects. No diffusion to other tissue than the skin is expected. Injections are not limited to the upper superficial layers of the skin but include the hypodermis (for fat & cellulite treatments). Various techniques of injection can be performed, including microdoses injections in superficial layers as well as retrograde, radial injections of rather high volume (1 to 2 ml per point of entry sometimes). Which Aesthetic indications can be treated with the MesoMedica line? All aesthetic indications can be treated with advanced Mesotherapy techniques ranging from skin ageing treatment and maintenance (mesoglow), skin sagging (mesolift), skin bleaching, hair loss & fat melting of cellulite and localized fat excess. Do I need to receive training on the technique & products? Even if Mesotherapy is fairly easy to perform and to apply, it is highly recommended to attend as many courses & workshops as possible and to read the appropriate literature to learn about advances in the field. The comprehensive Mesomedica line is of the highest quality & is ideal for all of the aesthetic Mesotherapy treatments you will perform. How easy is it to incorporate it into my existing practice? Aesthetic Mesotherapy is the best and easiest way to start practicing aesthetic medicine by incorporating an aesthetic practice into your existing practice. Indeed, upon evaluation, numerous patients are presenting localized fat excess, hair loss or skin ageing. Mesotherapy is so logical & easy to learn and that it allows you to enter immediately in the practice of this booming field. Is Mesotherapy Painful? Multiple injections can often be painful, however in Mesotherapy there are ways to minimize the pain inflicted to the patient. The pain felt by the patient will depend on: a.) The properties of the mixture injected. The products’ mixture plays an important role in the level of pain. The main concern is to keep the Ph between 5.5 and 7, so physicians must use caution with compounds such as retinoic & glycolic acids. The other pain concern would be with the PPC (PhosphatidylCholine) which must be mixed with lidocaine 2 % in order to control the pain resulting from the inflammation. b.) The choice of devices used by the physician (needles & mesoguns). The amount of pain resulting from Mesotherapy injections is directly linked to the speed of penetration of the needle into the skin. The faster the penetration, the less pain for the patient. The use of a good fully-automatic mesogun able to penetrate the skin in a fast, more steady and repetitive way will help at easing the pain. Ideally, doctors should use a fully automatic gun which uses pneumatic force to power the needle (Such as the French made U225) only so that the speed of penetration of the needle will be high and the weight of the device penetrating the skin is low (only needle). c.) The technique of injection itself and the skills of the practitioner. In non-experts hands the special needles used for manual Mesotherapy injections into the dermis (Lebel needles) can significantly contribute to making the treatment more painful, mainly because of the size of 27G. In general a 30G or 32G needle is recommended. In addition, receiving the latest & most complete training on Mesotherapy techniques will increase the practitioner’s skills & will assure him of a pain-free technique of injection. d.) The fear and perception of the patient. Some patients are needle phobic. Other means of treatment include needleless Mesotherapy (please refer to that paragraph below) or giving appropriate local anesthesia. This can be achieved with classical means like applying BLT cream (Benzocaine + Licocaine + Tetracaine) and/or using skin cooling systems (skin cooler or Nitrogenous sprays). We also recommend nitrous oxide inhalation but this requires purchasing the appropriate equipment. Do I need a mesogun? The answer is yes…and no. Yes, as it definitely leaves you with less hand fatigue when injecting big amounts of products repetitively. Choosing the U 225 mesogun (the only pneumatic gun that allows 300 shots par minutes) will allow you to get additional fraxel effect (shrinkage like laser) in addition to other benefits. Another advantage is psychological: using a fancy device for the injections makes you look more professional in front of your patients & their needle phobia will be reduced as they see you use a mesogun. Now if you consider your skills and expertise to be good enough to compete with automatic devices you will prefer the manual technique over the use of a mesogun. What are the side effects and contraindications of Mesotherapy? The only short-term side effects of a Mesotherapy/lipodissolve treatment are pain (manageable), bruising and inflammation. Skin necrosis can occur with PPC injections that are too superficial. Be sure to inject the product at least 8 mm into the fat in order to avoid this side effect. Bruising is linked to both the technique used for the injections and the gauge of the needle used. If you use a fully-automated pneumatic (without vibration) mesogun and a 30 g needle you will be on the safe side. Using arnica Montana 5 CH homeopathic products in preparation is recommended as well as performing post treatment massages with cream containing arnica Montana and/or Vitamin K (right after the injections). Is it preferable to use pre-mixed products or to mix the products myself? Using premixed product may seem like an easy and quick approach for aesthetic Mesotherapy, however it is not recommended mainly because of its lack of flexibility. Opposite of that approach lies a more intelligent and a more adaptable way to practice Mesotherapy which is mixing extemporal products. Every patient is different from one another, & therefore may require formula adjustments & every practitioner may also have its preferences as to which products to use for each indication. Mixing the products yourself requires good guidelines and following protocols but the results are greater efficacy and results in accordance to a more specific approach of the problem for each particular patient. What are the legal implications I need to know before performing Mesotherapy on my patients? Doctors & nurses have the appropriate and legal qualification to inject & are therefore legally entitled to practice Mesotherapy. The technique of Mesotherapy is of course legal in itself because this is only a specific technique of injection. In addition, health practitioners are the sole deciders as to which products they decide to use on their patients. The products used in Mesotherapy should be officially registered in the particular country they are sold and used. They are usually used “off label” by practitioners as they will be injected instead of being applied onto the skin as a traditional cosmetic product would be. Off label use is legal, as doctors are allowed to use any product they consider useful in any specific or particular indications. Practitioners of course are liable for the quality and sterility of the products they use and of the mixture they choose to inject. That is why high-quality & safe products must always used in the treatments. How long & how can the products be stored when opened? For that important question two different factors are involved: First it is mandatory to check the expiry date printed on the vial of the products purchased. Second, for multidose vials, it is recommended to properly disinfect the rubber cap each time a new and sterile needle will be used to extract the solution. Make sure not to leave a needle permanently into the vial. A specific device called “vial adapter” can be used when dealing with multidose vials. Multidose vials must always be kept refrigerated & should be used no more than 45 days after the first use. What is needleless Mesotherapy & is it an efficient alternative to injections? Some devices which are on the market today were mainly created for non physicians to let them use the same mixture and protocols used in aesthetic Mesotherapy but without the needles. Even if a technique like microporation allows the deep penetration of some large molecule it will never deliver the same amount and the same concentration than Mesotherapy using needles. In short, practitioners may consider using such devices only for a softer and less efficient approach & to complement the real Mesotherapy.


Curriculum vitae willem j van son

Medical Study University Hospital Groningen 1968 - 1974“Militair Hospitaal A. Mathijssen” Utrecht: assistant Internal Medicine (doing my militaryservice) 1975-19761976 - 1981: Training dept. of Internal Medicine, University Hospital Groningen1987: PhD; Thesis “Studies on systemic effects of Cytomegalovirus infection after RenalTransplantation”01-11-1990: Registered as Nephrologist (NIV

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