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MESOTHERAPY Dr. Tarek El Tanbouli.

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1 MESOTHERAPY Dr. Tarek El Tanbouli

2 This term is suggested by Dr.Michel Pistor (French doctor 1958).
Injection of small doses of medications in the mesoderm with very good effect on treating dermatological lesions (ectoderm) or even internal lesions as GIT (endermic). This term is suggested by Dr.Michel Pistor (French doctor 1958). Meso.= Middle; since we are aiming at correct location. OR = mean : Intermediary dosage between Allopathic therapy and Homeopathic therapy. Dr. Tarek El Tanbouli

3 History After many previous studies in Europe started 1793 (Belgium + France) for injecting local anesthetics and histamine to treat musculoskeletal, tendon and Trigeminal pain lesions. In 1948 Dr. Michel Pistor started pain treatment mainly with local infiltration of Procaine. Dr. Tarek El Tanbouli

4 History (cont.) In 1958, the name Mesotherapy is suggested for the 1st time after discovering more injection sites to treat more medical problems. In 1964 Dr.Pistor founded the French Mesotherapy Society. In st International Mesotherapy Congress. and the 1st Hospital outpatient service for Mesotherapy is created. 2002 creation of University Diploma in Marseille, Bordeaux and Paris. Dr. Tarek El Tanbouli

5 Indications A) Aesthetic: Lipolysis. Cellulite. Hair loss. Scar.
Anti ageing. Meso-Buttox. Dr. Tarek El Tanbouli

6 Indications (cont.) B) Pain: Sport’s injuries.
Chronic inflammatory disorders (Rheumatic, Sacroiliatis, Knee & Shoulder osteoarthritis, etc…) C) Others: G.I.T. disorders,insomnia, tonsilitis … etc Dr. Tarek El Tanbouli

7 D.M. ( O.k. if controlled –be sure ) Heart Dis. (arrhythmias )
Contraindications Pregnant Female. Nursing Female. D.M. ( O.k. if controlled –be sure ) Heart Dis. (arrhythmias ) Children. Dr. Tarek El Tanbouli

8 Instructions After Treatment for 24 hrs.
No Exercise. No Massage. No Hot Shower. No Caffeine. Dr. Tarek El Tanbouli

9 Drugs Used Dr. Tarek El Tanbouli

10 PPC Caffeine Aminophylline Yohimbine L – Carnitine Co enzyme A
A) Lipolytic drugs: PPC Caffeine Aminophylline Yohimbine L – Carnitine Co enzyme A Dr. Tarek El Tanbouli

11 B) Trophic drugs: Silicum = Conjunctyl Vit. C Multivitamins Artichoke
Na pyruvate Hyaluronic acid Dr. Tarek El Tanbouli

12 C) Vasodilator drugs: Calcitonin Fonzylane Torental Dicynone
D) Local anaesthia Lidocaine Dr. Tarek El Tanbouli

13 Phosphatydilcholine The best lipolytic drug is PPC without any effect on weight loss. Either injected pure (Brazil) or diluted with saline Or in combination e.g.; Lidocaine 2.5 ml Saline ml PPC ml Aminophylline 5ml In France PPC is not allowed; so using local anesthetic + Lipolytic drug + Trophic drug + vasodilator drug. Dr. Tarek El Tanbouli

14 Phosphatydilcholine (con.)
PTC is lecithin from soya beans ( have 2 unsaturated fatty acids = linoleic + alpha linoleic acid) PTC is produced in the body but have saturated fatty acid ( Palmitic + oleic + streaic acid ) in cell membrane of: Liver cells. Adipocytes. Lungs of embryo from 4th month. “with more palmitic acid” preventing its sticking so allowing inflation + deflation of lungs (stimulate lung surfactant) Dr. Tarek El Tanbouli

15 Phosphatydilcholine (con.)
PTC. To be injectable needs: A solvent which is deoxycholic a. ( gallic a.) A preservative which is Benzyl alcohol ( now known as PPC). PPC max. dose in lipolysis = 2500 mg / session (every 4 – 8 w ) Each area needs 1 – 4 sessions to get the results. (72 % of pt. need 2 session only). Dr. Tarek El Tanbouli

16 1% are transported to kidney.
PPC helps dissolving the double layer of adipocytes producing nano size fat particles. At the same time, helps enzymes of mitochondria of adipocytes to break down the triglycerides into mono ( continue for 8 w ). 99% of dissolved fat transported to liver where metabolized into CO2 + H2O. 1% are transported to kidney. Dr. Tarek El Tanbouli

17 Types of injections IED = Intra Epidermic (1 mm depth)
IDS = Intra dermal superficial (1-2 mm depth) N = Nappage = multi-pricking technique for cellulite + mesolift PPP = point by point or papule technique for tonsillitis + insomnia IDP = Intradermal (4 mm depth) for hair loss 3 mm by oblique injection. Mesoperfusion ( 5-6 mm depth) IHD = Intra hypodermic (6-13 mm depth) for lipolysis + iliolumbar lig. pain Dr. Tarek El Tanbouli

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22 Cellulite It is lumpy, orange peel, or cottage cheese appearance of skin by strangled fat cells. Fat cells are held in place by a mesh of collagen fibers in the subcutaneous tissue. If fat cells bloated with water or fat, cellulite appears i.e. “fat cells bulge out the mesh of collagen fibers”. Dr. Tarek El Tanbouli

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26 Factors Causing Cellulite
Hereditary Pregnancy Drainage problem (sp. lymphatic ). Obesity Dr. Tarek El Tanbouli

27 Interstitial or extracellar matrix is composed of:
Fibroblasts (structural fibrous protein ) Glycosaminoglycans Glycoprotein (adhesive ptn.) Proteoglycans Dr. Tarek El Tanbouli

28 Cellulite appears if interstitial matrix is affected by:
Decreased collagen function + production Decreased Elastin Decreased Flow of micro circulation ( due to acidosis + increased free radicals Increased capillary permeability leading to increased free water and then lipedema Dr. Tarek El Tanbouli

29 Cellulite classifications
1st degree = cellulite does not appear if skin is punched. 2nd degree = cellulite only appear if skin is punched but not appear during standing or laying down. 3rd degree = cellulite appear during standing and punching the skin but not on laying down. 4th degree = in all condition. Dr. Tarek El Tanbouli

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31 Treatment of cellulite
Decrease lipoedema by Procaine + Benzopirone. Stimulate micro-circulation by Procaine + vit C + penthoxiphylin. Stimulate lipolysis by procaine + PPC ± theophylline ± caffeine ±carnitine ±yohimbin. Stimulate C.T. regeneration by Conjunctyl. Dr. Tarek El Tanbouli

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36 Treatment of Flacidity of Arms and Inner thigh
DMAE : Di methyl amino ethanal using 2 – 4 ml (25 mg / ml). Vit.C using 2 ml (222 mg / ml) Procaine using 1 ml (2%) For one thigh or arm. Need 20 treatments with 2 weeks apart by PPP or Nappage injections. Dr. Tarek El Tanbouli

37 Complications You have to alert your patients to all side effects:
1 ) Vasovagal Syndrome: Vasovagal Syndrome due to many injections ( ) a- Before treatment ask pt. If dizziness or nausea occur to stop injections and give O2 mask for 2-5 min at L /min. Ask pt. to stay after injection in the clinic to be sure no loss of consciousness. Dr. Tarek El Tanbouli

38 Complications (cont.) b - Before treatment eat sugary or ptn. diet (more empty stomach more attacks). c - Injection better while lying down more than standing position which may be lethal with loss of consciousness. Dr. Tarek El Tanbouli

39 Complications (cont.) Pain:
Dull or burning pain at area of injection which become warm + red, within 5 min, lasts from 10 min. To few days. Not treated by NSAID’s but better with mild narcotics as Hydrocodone or weak opiods e.g. tramal or distalgesic. Nodules: occurred with non expert doctors or increased conc. of PPC. swelling: may start immediately + persist 1 week or more. Dr. Tarek El Tanbouli

40 Complications (cont.) Bruising: persist 1 – 2 weeks so pt. must plan their treatment according to their schedule sp. wedding, swimsuit & modeling photo shoots. Nausea – or + diarrhea: due to cholinergic reaction (sp. aminophylline 250 mg) Treatment: Antiemetic or H2 blocker (Zantac). Dr. Tarek El Tanbouli

41 Complications (cont.) Palpitations: Allergy:
Increased in Hypertensive pt. Give O2 mask + diazepam ( tranquilizer ). Occurs with: a) aminophylline if its serum level >20 mg / ml. b) Yohimbine (parasympathomimmetics). Allergy: Sp. with a) Hyaluronidase b) PPC. Treat as any allergic reactions; Dr. Tarek El Tanbouli

42 THANK YOU Dr. Tarek El Tanbouli

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