Body Sculpturing

Mesotherapy / Lipodissolve /
Carboxytherapy / Liposuction
October 2005
 Dr Kee Lee TAN
MBBS FRACGP MCPSA FFMACCS

Fellow of Australasian College of Cosmetic Surgery

Member of Cosmetic Physician Society of Australasia
Member of American Society of Cosmetic Breast Surgery
Hononary Fellow of Hong Kong Academy of Cosmetic Surgeons and
Physicians
 Mesotherapy
Pioneered in1952 by French doctor Dr Michael Pistor.
Its superficial subcutaneous injection of low dose of
medications
Directly injecting drugs to affected sites
Skin is used as a drug administration organ
It promotes the bodys circulatory, lymphatics and
immune system to create a biological response and
reverse abnormal physiology
Mesotherapy = Treatment of Mesoderm
 Mesotherapy
Many different types of drugs used
Many different brands and manufacturers
Beware of quality of drugs
Ensure that production is TGA and/or FDA certified
 Lipo-dissolve
Process of dissolving body fat using
injectable drugs
Drugs such as PPC, Aminophylline
Mesotherapy vs Lipodissolve
Dont be confused
Just terminology
 Indications of mesotherapy
Cosmetic indications
Medical indications
 Cosmetic Aesthetic Indications
Obesity, weight loss (lipodissolve)
Cellulite reduction (lipodissolve)
Face and neck rejuvenation (Mesolift)
Body sculpturing (good in conjunction with liposuction)
Hair loss and Alopecia (mesotherapy)
Medical Indications of Mesotherapy
Muscle spasms
Stress
Insomnia
Carpal tunnel
Tennis elbow
Fibromyalgia
Osteoarthritis
Migraines
Sports injuries
Others
 Mesotherapy
Doctors need to know pharmacology
Get good products.
Products production quality control in important
Proper laboratory with FDA approval
Most products have short shelf life.
Ensure products are transported without losing its
efficacy
Need to ensure ingredients are TGA/FDA approved
 Mesotherapy
Drugs are administered superficial to avoid resorption
and hence remain localised to area of injection
Superficial subcutaneous
Always use mesotherapy drugs with procaine
But avoid cocktails, avoid mixtures when just starting.
 General Technique
Mechanical or electronic injection
30G needle
Length of 4mm (neck up) to 6mm (trunk)
Syringe 1 ml to 10ml
Depth of injection : 2mm to 6mm deep, up to 13mm
Intradermal and subcutaneous depending on substance
Angle 30 and 60 degrees or 45 and 90 degrees
To ensure getting intradermal and subdermal level
Distance 0.5cm(face) to 2cm(body) apart
Dose : variable to each product (usually 0.1ml-0.3ml)
Schedule : variable (usually weekly for 10 weeks then
monthly maintenance)
 General Technique
Nappage Technique
Multiple points of injections very close, 2 to 4 mm
apart
Angle of needle 30-60 degrees, in parallel lines using
a 4 or 14 mm needle and regular pressure
For face
 Precautions
Avoid enzymes for beginners
mucopolysaccharides/mucoperoxidase
destroys lymphatics hence cause edema
Avoid cocktails for beginners
Avoid too deep as have systemic effect
For phosphotidylcholine, avoid 2mm deep as cause
necrosis, hence 4mm-13mm
 Complications and After effects
Swelling +++
Pruritis
Pain
General effects
Flushing/vagal response/allergy/nauseas
Hematoma/bruise
Infection
Necrosis
Staining from iron
Did not work
Non responders
 Pharmacology
Vasodilators (increase circulations)
NSAID (anti-inflammatory)
CNS sedatives (muscle relaxant)
Enzymes (decrease scar tissue)
Nutrients (stimulate repair)
Vaccines (stimulate immune system)
Antibiotics (anti-infection)
Hormones (hormone replacements)
Hormone blockers (Hair growth)
Anaesthetics (increase circulation)
Others
 Pharmacology
Drugs must be
-isotonic
-water soluble
-non allergenic
-becareful when use enzyme (destroy
lymphatics hence edema)
-non oil base as will cause granuloma
-do not cause
-nodules/abscess or necrosis
Many different type of drugs used
 Pharmacology
Multiple pharmacological effects such as
Alpha adrenergic receptor blockade
-vasodilation
-lipolysis
Insulin receptors
Peptide receptors
Anaesthetic effects
Restoring microcirculation
 Pharmacology
Weight lost
Caffiene
Aminophylline
Yohimbine
L-carnithine
Phosphatidylcholine
Vascular/circulation
Prociane
Facial rejuvenation
17 B Estradiol
Glycolic acid
Hyaluronic acid
Vitamin C
 Mesotherapy Drugs
Alkaloids
Methylxanthine
Aminophyline
Penthoxyphyline
Caffiene
Alpha adrenergic blocks
-cause vasodilatation hence Increase drainage
L-carnithine
-works on mitochondria hence increase metabolism
Phosphotidylcholine
Procaine
-local anaesthetic effect
-restore normal function of cell
Amino acids
Others
 Caffeine
An alkaloid
Structurally related to methyxanthines alkaloids,
theophylline and theobromide
Is a bronchial smooth muscle relaxant, CNS stimulant, a
cardiac muscle stimulant and a diuretic
Aminophylline and caffiene are active ingredient of most
cellulite cream
Action
Increase blood flow
Stimulate fat cells to release lipids and promote cellular drainage
Tightens and tones skin
 Aminophylline
An alkaloid
is a mixture of theophylline and ethylenediamine
Must be kept in cool dark place
Action
Promotes fat breakdown
Increase blood flow by dilating blood vessels
 Phosphatidylcholine
Most abundant phospholipid component in all cells
A fat burner hence melts away fat and cellulite
Use widely for weight lost programme
Main role in cell-membrane integrity
Action
Increase cholesterol solubility
Alter composition of fat deposits
Inhibits plaque aggregation
 L-Carnitine
Classed as amino acid
Facilitate long-chain fatty acid entry into cellular
mitochondria, hence delivering substrate for
oxidation and subsequent energy production
Fatty acids are utilized as energy substrate in all
tissue (except brain)
Action
Helps metabolize stored fats into energy
during physical activity
 Yohimbine
Alkaloid
An aphrodisiac
Action
Block alpha2-adrenergic receptors hence increase
blood flow via vasodilatation
 Procaine
Well known, safe , non-toxic local anaesthetic since
1905
Action
Local anesthetic effects
Restore normal functioning of damage tissue
Enhance absorption if other druges that it is injected
with
 17 B Estradiol
A hormone from wild yam
Most commonly used source of estrogen for natural HRT
Relatively small lipid soluble molecule, hence easily
absorbed by skin
Actions
Stimulates proliferation of fibroblast
Stimulates new collagen formation
Influences the turn-over of macro-molecules
 Glycolic acid
Alpha Hydroxy Acids (AHAs)
From sugar cane
Actions
Stimulate new growth of skin and collagen
Decreasing the bond that holds dead skin cells on
suface
 Hyaluronic acid
A natural living substance
Used in treatment of aged and dehydrated skin
 Vitamin C
Used in stretch marks and skin rejuvenation
Widely used in creams and injectables
Actions
Collagen formation
Anti-oxidant
Key immune system nutrients
 Main Mesotherapy treatments
1) Cellulite treatment
2) Fat reduction
3) Lower eyelids
4) Chin
5) Mesolift
6) Mesobotox
7) Hair loss
Cellulite Treatment
 Cellulite
A multifactorial pathophysiology
Genetics
Diet
Mechanical
Endocrine
Due to accummulation of fat under skin, not
excess fat, with increased in fibrotic tissue under
the skin.
Hence giving the peau dorange look
Edema ie vascular exudate
 Stages of cellulite
Stage 1 and 2
Capillary and vascular extravasation
Stage 3
Bigger size adipocytes surrounded by an
abnormal network of collagen fibers
Stage 4
Painful subcutaneous macronodular adipose
tissue
 Cellulite treatment
Many ways
Massage, diet, pills, exercise, Qigong,
Acupunture etc
Liposuction
Carboxytherapy
Lymphatic drainage
Endomologie
Ultrasound
Contour Lift
 Cellulite treatment
Injection depth 2-4mm
Injections points 2 cm apart
Injection technique bevel up, alcohol
Schedule of procedure
1 week apart
2 weeks apart if also use PPC
Primary cocktail
yohimbe/aminophylline/procaine/DMAE/Pentoxifylline
(2mls each)
Dosage
All in 1 syringe, may use 2-4 syringes depending on size
 Cellulite protocol
Weekly treatment
6 10 sessions
Can use with other modality
Endomologie
Liposuction (use it post)
Subcision to release underlying scars
Massage
Microdermabrasion
etc
 Cellulite results
Responders
Decrease in volume
Reduction of cellulite
Skin more elastic and firm
Non-responders
Nothing happen!
Fat reduction
 Obesity
Surgeon General USA 2003 the number
one health problem facing America
Due to Increased in Adipocytes number
and size
Lead to multiple associated medical
problems : IHD, CVA, NIDDM etc
 Obesity Treatment
Many ways
Diet, exercise, Qigong, Acupuncture,
hypnotherapy,
Medical treatment
Medical diets
Medications (reductil, duromine, xenical)
Liposuction
Carboxytherapy
Gastric banding
Behavioural modification techniques
Mesotherapy / Lipo-dissolve
Obesity treatment Mesotherapy
Based on Lipolysis
Inhibit phophodiesterase
Increase cAMP
Stimulate Beta receptors
Inhibit Alpha-2 receptors
Stimulate cofactor of fat metabolism
 Lipolytic drugs
Phosphatidylcholine
Aminophylline
Caffeine
Yohimbine
Artichoke
L-carnitine
 Fat reduction treatment
Injection Depth 13mm deep
Injection Points 2-4cm apart
Injection Technique
bevel up
manual injection with syringe with PPC
Schedule of procedure
2-3 weeks apart
Cellulite and skin treatments can be administered in
between these sessions
Average 5-10 treatments
 Fat reduction treatment
Ingredients
Phosphatydylcholine(PPC) 100mg/ml
Procaine 20mg/ml
Other formula
Hyaluronidase 4mls
PPC 2mls
Aminophylline 2mls
Yohimbine 1ml
Marcaine 1ml
 Fat reduction treatment
Dosage
Max dose per session over multiple area : 2500mg PPC
1st session <500mg to assess S/E
PPC should always used in 50mg/ml concentration**
Inject 20mg(0.4ml) PPC at each site
Lidocaine or Procaine is to be used with PPC at 50:50**
Hence 1ml PPC + 1ml 1% Procaine (used within 24 hours)
50ml bottle mix 25ml 100mg/ml PPC + 25ml of Procaine 1%
Equals 2500mg PPC in 50ml bottle=10 x5mls syringes
At 20mg(0.4ml) per injection, therefore, no more than 130
injection points
No massage or rubbing for 12 hours
 Fat reduction treatment
Contraindicated
Children
Pregnant women, nursing mother
Diabetics with vascular problmes
Autoimmune disease
Liver disease
Severe obesity
Acute or Chronic infection
S/E
Swelling +++
Redness and soreness
Suggest wear loose clothes for 2-3 days
Mesolift
 Mesolift
Injection Depth 2-4mm deep
Injection Points point to point / Nappage
Injection Technique
Inject 90 & 45 degrees to deposit in dermal and intradermal
Schedule of procedure
Weekly sessions
Minimum of 10 sessions
 Treatment
Inject all over face
Avoid
nose
Lips
Orbits
Combine with other modality
Creams
Microdermabrasion, chemical peel
Laser and IPL
Thermage, RF etc
 Mesolift
Benefits of mesolift
Skin revitalizing
Nutritional improvement
Hydration improvement
Fibroblast stimulation
Increase collagen production
Free radicals blocking
Hydrating action
Restore skin tone
Restore dermoepidermic cohesion
 Mesolift
Suggested cocktail
Week 1
Syringe 1 (x)
17 B Estradiol 1.0ml
Procaine 2% 2.0ml
Syringe 2 (o)
Vitamin C 222mg/ml 3.0ml
Lidocaine 1% 2.0ml
Week 2
Syringe 1 (x)
17 B Estradiol
Procaine 2% 2.0ml
Syringe 2 (o)
GAG 0.5ml
Hyuralonic acid 2.0ml
Trissilinol 0.5% 2.0ml
Lidocaine 1% 2.0ml
 Mesolift
Other cocktails
Polyvitamins 2mls
Hyaluronic acid 2mls
Marcaine 1ml
Silicium 1mls
Zinc 0.5mls
 Side effects
Swelling++
Pain
Need to use topical eg Emla and Anestop
Bruising
Hematoma
Allergy
Lower eyelids
 Lower eyelids
Accumulation of fat in lower eyelids
Localised lipodystrophy
Genetics
Unknown etiology
 Treatment
Use 30G needle, 1 inch needle
Cocktail each side
1 ml Aminophylline 25mg/ml
1ml Phosphatidylcholine 100mg/ml
1ml Marcaine 2%
Inject perpendicularly in a retrograde manner (like
injecting aquamid)
Only one entry point and one tunnel per eye
Dont have to empty whole syringe, inject 0.5 to 0.75ml
each side
Repeat in 6 weeks
Usualy two teatment is sufficient
 Adjuvant therapy
Steroid orally to reduce swelling
Start 3 days before
Prednisolone 35, 30, 25, 20, 15, 10, 5mg
Diuretics
Lasix 20mg morning
Chin
 Chin
Double chin
Treatment
Exercise, diet, endomologie, etc
Liposuction
Mesotherapy
Cocktail
Similar to eyelid
 Treatment
Use 30g needle
Length 1 inch
Inject in a retrograde manner
Inject 1ml per area
3 areas under jaws
Area 1 : under chin
Area 2 : L side
Area 3 : R side
Summary
 Important Points
If you dont know, avoid mixtures
It is better to use one drug at a time, plus Procaine 2%
Small amounts at many points
One session/week
One or two session/month for maintenance
Intradermic 2-4 mm superficial level of injections
General rules regarding needles length
4mm face
6mm body
13mm fat ( PPC)
 Mesotherapy / Lipo-dissolve
Multiple usage
Doctors should start slow
Get to know your drugs/cocktails
Improve your techniques
Use a meso-gun or multi-injector
Start off with cellulite treatment, fat reduction and
mesolift
Use mesotherapy together with chemical peel,
microdermabrasion, dermal fillers, lasers, IPL,
liposuction.
Photos
 Patient 1

Lipo-dissolve with
PPC/Aminophyline
L arm 1 week
3 weeks
R arm 1 week
3 weeks
 Patient 2

Lipo-dissolve with
PPC/Aminophyline
2 weeks (1 treatment)
 Patient 3

Lipo-dissolve with
PPC/Aminophyline
1 week later (1 treatment)
Patient 4
1 week
2 weeks
1 week
2 weeks
 Patient 5

Lipo-dissolve with
PPC/Aminophyline
1 week
4 weeks
4 weeks
4 weeks
 Patient 6

Lipo-dissolve with
PPC/Aminophyline
2 weeks
2 weeks
 Patient 6

Lipo-dissolve with
PPC/Aminophyline
3 weeks
 Patient 7

Lipo-dissolve with
PPC/Aminophyline
1 week
2 weeks
1 week
2 weeks
Patient 8

Liposculpture
Liposculpture
Patient 9

Liposculpture
 Patient 10

Liposuction followed by
Carboxytherapy
Carboxy therapy
 Combination therapy
Can combine liposuction with
mesotherapy/lipodissolve
Liposuction for big areas. Followed by
lipodissolve for small or difficult areas
Lipodissolve to clean up after liposuction
Thank You