Dr Philippe Hamida-Pisal discusses the evidence base for clinical efficacy of mesotherapy
In aesthetic medicine mesotherapy can be defined as a non surgical technique aimed at diminishing problem areas in the skin such as cellulite, stretch marks, excess weight, body contouring, and face and neck rejuvenation, to name a few. It is administered via numerous microinjections that contain various types of CE approved medicines, vitamins and minerals. This technique was developed in France in the 1950s, and it was recognised by the French Academy of Medicine in 1987.
Aesthetic mesotherapy addresses skin rejuvenation, cellulite, sun damage, scar reduction and alopecia. There are various indications for mesotherapy, including pain management and aesthetic mesotherapy. For pain management there is a different field of mesotherapy, where this technique is used to relieve rheumatism, arthritis and muscle pain and sports injuries, amongst many other. Another uses include smoking cessation, allergy and ophthalmological pathology.
In the aesthetic field, the concern is primarily the effectiveness of the poly-revitalising solutions employed in mesotherapy and what happens in skin when those solutions are used.
To treat using mesotherapy, a solution containing small amounts of various substances such as vitamin C, vitamin A, vitamin E, vitamin B in nearly all its forms, amino acids, minerals (like calcium, phosphorous and magnesium), nucleosides, coenzymes, antioxidants, and hyaluronic acid is injected. This solution is injected into the epidermis and the dermis using three injection techniques. It is also possible to use micro needling or a meso-gun.
Both young skin and more aged skin can be targeted. In aged skin the treatment aids hydration, reduces the anti radical action and fights against the effective of oxidative stress. Radiance can also be achieved, improving the density, the tone of the skin, and its tonicity. The results of mesotherapy are progressive and accumulative and the advantage is that it is non-invasive and non-traumatic.
Beautiful skin tends to be defined as smooth, even coloured and tone, radiant, firm and plump, with small pores, no wrinkles, no blemishes, no sagging, and no hyperpigmentation. Everyone desires luminescent, glowing, hydrated skin; a skin that is neither too dry, nor too oily, and would like to keep it this way forever. However, unfortunately the ageing process catches us all.
After the age of 30, it’s common to see that the eyebrows begin to descend. In our 40s, we may have excess eyelid skin, the glabella frown lines start to show and the nasal brow will fall also. By the 50s, forehead wrinkles start to show, the glabella becomes more pronounced and there is excess skin and vertical lines in the perioral region. When we arrive in our 60s, things get a bit worse. There are perioral and neck wrinkles, the nose begins to droop and the glabella becomes even more pronounced. By the age of 70 these developments become more visible as the skin thins even more. We also note a reduction in facial fat and a loss of volume. Muscular hyperactivity is a further reason of skin ageing.
There are internal and external factors affecting ageing. Internal factors include genes, time, evolution and expression. When we look at external factors we find smoking, sun exposure, lifestyle, and pollution. For instance, those living in London are likely to age quicker than those in Cornwall.
So what happens to the skin? The epidermis thins, and the rate of cell renewal decreases. Photo ageing causes thinning of the epidermis with abnormal keratinocyte differentiation and dryness of the stratum corneum, which is due to the lack of hyaluronic acid.
When the junction between the dermis and epidermis thins, the ageing process becomes more pronounced in the dermis. A quantitative and a qualitative change occurs in collagen types I and III and changes to the fibroblasts – the extracellular matrix and collagen, the structural framework for human tissue.
Understanding the ageing process and the importance of fibroblasts is the key to understanding how mesotherapy works.
The fibroblasts are concerned primarily with maintenance and tissue metabolism and their correct functioning is responsible for structural and biochemical alterations, change in perception, permeability and capacity of scar formation. Fibroblasts make collagen, glycosaminoglycans, reticular and elastic fibres, glycoproteins found in the extracellular matrix, and cytokine TSLP. They also represent the major skin type in the dermis and are responsible for producing and maintaining the extracellular connective tissue, which gives the skin its youthful look.
However, as time passes, fibroblasts stop being able to keep the skin looking youthful. The exact reason why remains unclear, but what we do know that there is an important reason for this change in the dermis—perhaps an age related increase in oxidative stress, due to alteration in the balance between production and elimination of reactive oxygen.
Each of the components used in mesotherapy solutions such as NCTF HA has a physiological effect on the skin cells. The main principle is that ageing skin is supplied with various substrates that are key to the adequate functioning of the fibroblasts. These include vitamin, mineral element, amino acid, nucleotide, coenzyme and antioxidant as well as hyaluronic acid. Fibroblasts will work more efficiently if they are provided with the nurturing environment in which they can function properly, and the substrate substance looks after creating such an environment.
Putting all these multiple components together is not enough to guarantee the actual efficacy, as they need to maintain the stability and integrity in the formulation. It is very important to note that the formulation is sterilised by double filtration and not autoclaving, because those substrates are very sensitive to the heat.
In terms of ingredients, we have vitamin C, vitamin A, vitamin E, and the whole range of vitamin B.
Amino acids represent a substrate required to build the extracellular matrix protein, mainly the collagen. The three main minerals found in mesotherapy solutions are calcium, phosphorus and magnesium. Calcium is the main iron used to regulate cell homeostasis. Phosphorus is essential for cell wall regeneration and all the biological membranes. And magnesium is required to maintain more than 180 normal enzymatic reactions.
We also have some nucleosides—five which are necessary to replicate DNA for fibroblast fission. Then, co-enzymes which are biochemical reaction catalysers. There are also some other antioxidants, such as the tripeptide glutathione which is among the most efficient endogenous antioxidants, and finally we have hyaluronic acid, which has an anti-inflammatory action. It is antifungal and it also attracts 1000 times its weight in water (which maintains and improves the hydration of the skin).
- Vitamin C, as we all know, is an antioxidant. It has antioxidant effects, and regulates, and speeds up the DNA synthesis and it’s essential for
- Vitamin A is retinol, which is an antioxidant as well, that increases its action when combined with the vitamin C, and that regulates the epidermis regenerations and amino acid activities. It also controls all gland activities.
- Vitamin E has a high level of antioxidant activity. It controls skin’s physiological regeneration and starts repair processes in the case of skin damage.
- Vitamin B is very important as an antioxidant, but also to release the energy necessary for the fibroblasts to work with efficacy.
Preclinical and some clinical trials evidence is available to support the effectiveness of mesotherapy treatments, as well as long-term international experience in the clinical use of such preparations.
Studies of mesoneedling show that the formation of new collagen and elastin after passing a needle has an increase of 206%.
Studies looking at a simulation of cell multiplications on young skin and on aged skin, show 147% for young and 148% on more aged skin. New collagen stimulation shows an increase of 166% intracellularly and 256% extracellularly, and protection against oxidative stress can increase up to 90%.
I have studied patients in Paris and London, who showed amazing results after just five sessions of mesotherapy—which is standard amount we recommend. The results varied in each individual case, but in general we can say that the quality of the skin improved overall, including reductions of crow’s feet as well as nasolabial fold, and an evident reduction of pigmentation. Applied on a regular basis, mesotherapy reduces sun damage, and we see this when we use such solutions for ageing hands, where loss of firmness and sunspots are clearly improved.
Possible side effects
Short-term side effects, such as mild pain, redness, swelling, and bruising are relatively common and an expected consequence of the injections themselves, but true complications are rare. Occasionally, small lumps, bruising, swelling and discomfort may also occur. Disinfecting the skin before the treatment is important to avoid possible infections.
The goal of the poly-revitalising solutions is to create a favourable micro-environment for more optimal fibroblast activity. These solutions help fibroblasts work effectively. Mesotherapy in the aesthetic field is one of the safest existing techniques if it is done accordingly.
Dr Philippe Hamida-Pisal is the owner and Managing Director of PHP Aesthetic and PHP Wellness, Divisions of PHP Health First, a London based aesthetic treatment provider specialising in aesthetic treatments and bespoke skin care for model agencies. He is Founder and President of The Society of Mesotherapy of United Kingdom “SoMUK”.
The treatment is administered over about 20-60 minutes and the patient can immediately resume his/her activities of daily life. Although the therapeutic protocol will be based on the age and skin condition of the patient, about five-six sessions are usually needed, applied at two weeks apart.
Although the repairing and anti-ageing action of HYALURONIC ACID is immediate and long lasting, it does not stop the effects of ageing, so regular maintenance treatments should be applied every six months, for preserving the healthy appearance of the skin. This period may be shortened or extended based on the results obtained.
*Biorevitalization: Ancillary solution that helps the main substances (HA &/or SiO2) to produce an ideal result in skin disorders or diseases
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