Transcript Mesotherapy for facial skin rejuvenation

Mesotherapy for facial skin
rejuvenation: A clinical,
histologic and electronmicroscopic evaluation.
Amin S. et al.
Dermatol Surg 2006; 32: 14671472
Introduction
described by Michel Pistor in 1952
 consists of the injection of hormones,
enzymes, nutrients, pharmaceuticals,
detergents, and other substances into the
subcutaneous layer of the skin.
 originally developed to treat vascular and
lymphatic disorders.
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is an intriguing yet poorly studied method for:
-body contouring
-cellulite treatment
-lipolysis
few clinical studies have been published
showing the mechanism of action and active
ingredients of mesotherapy for lipolysis.
concern also raised for the potential adverse
effects
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Although synonymous with injection induced
lipolysis, it has also been used to treat a variety
of rheumatologic and dermatologic disorders.
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skin rejuvenation of the face is one of the latest
applications
-there are virtually no scientific peer-reviewed
publications
-rhytid reduction, increased elasticity, and
improved pigmentation have been anecdoctally
suggested, unthough umproven.
Objective
first clinical evaluation on the effect of
mesotherapy for facial skin rejuvenation.
 evaluates clinical, histologic, and
ultrastructural changes. Adverse effects
also recorded
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Methods
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10 subjects: exclusion: pregnancy, retinoid use,
lasers in the previous 6 months…keloid. (Table
1 ). 4 treatments in a 6 month interval.
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LMX (Ferndale Laboratories) topical anesthesia
under occlusion one hour before procedure.
injection of a 9:1 suspension in hyaluronic acid
gel (Hopewell pharmacy). Mixture immediately
before injection. (Multivitamin Mixture, not
specified)
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injections with needles with adjustable hubs
(figure 1), 1.5 mm long so that perpendicular
injection feasible.
0.01ml injected at 1cm intervals for a total of
200-250 injections (2-2.5ml)(figure 2)
ice packs applied after 5-10 min and observation
for 30 minutes for adverse side effects.
surveys performed monthly
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skin biopsies before first RX (angle of
right mandible) and biopsy done 6
months later at 1cm: -HE … stain
-electron microscopy evaluation
-blinded dermatopathologist:
-epidermal thickness
-vessel size and density
-solar elastosis
-elastin content
-collagen fibre diameter
by equal magnification electron
microscope photographs
-presence of sclerosis
-overall appearance
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photography (6.1 Mpixels) done before
treatment and 6 months after.
-evaluation by blinded physician using
-temporal sequencing (Table 2): max
20, min –20.
-individual parameters (0-3 points) (no
statictical analysis because only 10 patients)
-dyspigmentation
-rhytid level
-erythema
Results
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No significant improvement on the photograph
assessment (figure 4) (Table 3) (Table 4)
Microscopic evaluation showed no significant
changes in epidermal thickness, vessel size and
density, solar elastosis, elastin content, mucin
content, dermal thickness, collagen fibre
thickness, presence of sclerosis, and overall
appearance.
Electron microscopy showed a diminished
diameter of collagen fibres (Table 5)
 Several adverse effects noted, none
serious (Table 6).
 4 out of 10 patients described increase
smoothness to the skin and increased
tone in the skin, which did not persist
beyond one week after each session.
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Discussion
temporal assessment: value close to 0
implies no effect. Slightly negative values
could be explained by normal aging.
 the transient effect on skin smoothness
reported in 4/10 patients could be
explained by a transient oedematous
effect.
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decrease in the diameter of collagen fibers
can be explained by synthesis of new
collagen with follows inflammation or
thermal injury and is frequently associated
with the presence of a repair zone.
Questions
-evaluation at 1 year?
-more treatments?
-control group?
-more effective than other non ablative
treatments?
Due to the popularity of mesotherapy, future
studies will be required.