Aesthetic nurse Juan Lopez highlights the benefits of using mesotherapy for facial skin rejuvenation
Too often we focus our efforts on treating what patients request, without recommending or suggesting other treatments that would improve their general appearance. In this manner, I believe that we are not working hard enough to care for our canvas. For us, as aesthetic practitioners, the canvas is our patients’ skin, and therefore treatment of this organ should always be our first recommendation. Good skin health makes our patients look better, and will also help to improve the results of any other treatments implemented in the future, such as dermal fillers and botulinum toxin. If the skin looks better, the results of other treatments will be greater. This is comparable to an artist’s masterpiece – undoubtedly, any distinguished artist would ensure that their canvas was of the best quality, to assist them in creating equally high-quality work. Likewise is true of caring for our patients’ skin.
For the purpose of improving the skin, I believe in following in the footsteps of the French doctor Michel Pistor. In 1976, Dr Pistor first described a technique involving injections of medications directly into the skin, also known as mesotherapy.1 The aim of mesotherapy in skin rejuvenation is to maintain and restore a healthy and youthful texture. The desired final effect is to firm, brighten and moisturise the skin by injecting suitable products that are biocompatible and absorbable in the superficial dermis.2 It is also claimed that the injection of mesotherapy products promote skin rejuvenation by increasing both hydration and fibroblast activation, and re-establishing skin tone and elasticity.3 At present, mesotherapy is used to treat a variety of conditions such as acne, rosacea, cellulite, localised adipocytes, stretch marks and hair loss, as well as for skin rejuvenation. In this article I will highlight the case study of a patient with dry skin below the eyes and the mid cheek area.
The mesotherapy for hydration protocol consists of four sessions. These four sessions are carried out weekly or fortnightly depending on the availability of the patient. To ensure efficacy and even delivery of product to the skin, the treatment is performed with an automated mesogun, ensuring that each individual injection perforates the skin at the same depth and with the same amount of product.
Each session utilises the same protocol of products – in my practice I use a cocktail of products to improve different aspects of the skin. For skin hydration I use the following products and ingredients shown in Table 1. This protocol can be individually tailored depending on the requirement of the patient and their age. Generally, the mesolift cocktail can be changed for other cocktails, such as an anti-ageing cocktail or a firming cocktail. For example, if you have an older patient you can change the mesolift cocktail for the regeneration cocktail, which is better suited for older skin. The type of cocktail that I deploy for this effect contains centella asiatica as the main ingredient, believed to heal the skin, acting alongside dermal regenerative actives dexpanthenol, elastin and organic silicium, working to improve collagen fibres. If you have a younger patient, you can change to the radiance cocktail to help achieve glowing skin, which is what younger patients generally request. This protocol has been adapted from Dr Britta Knoll.4
Before considering any form of treatment it is crucial to take a thorough medical history, thereby ensuring mesotherapy is not contraindicated for any patient. This should be followed by a full explanation of what the patient can expect, the length of time that the treatment will take and the maintenance required to maintain the effects on the patient’s skin. The patient will need to be aware of the latter’s implications, commitment and potential cost in the long term. Following consent, and as part of the protocol, it is necessary to take photographs of the patient and the skin condition at the first visit as a baseline, before commencement of treatment. This is also crucial in each session before the treatment in order to be able to monitor and document the progress of the results.2
My protocol for mesotherapy for hydration is to repeat this treatment every two to three months, depending on the condition of the skin
As previously mentioned, it is important to distribute the same amount of product at the same depth in each injection. For that reason, we set up the mesogun to inject at 1mm depth and at a rate of 300 injections per minute. In my experience, patients find the treatment with the mesogun more confortable than manual injections. A study by Duncan and Chubaty5 describes how some practitioners reported that use of a mesogun improved the patient’s experience and lowered the perceived pain sensation.
Patient One is a 37-year-old female, who had visited my clinic previously to have treatment with botulinum toxin type A for facial dynamic lines, hyaluronic acid (HA) fillers for volume replacement and a hydrating HA product for hydration of the skin. Previous skin hydration with the HA product had had a positive effect but the patient found that by the end of the day the skin was suffering and very dry. On previous occasions we had discussed the use of a course of mesotherapy treatment for skin hydration in the area of concern. Following consultation, the patient agreed to undergo four sessions of mesotherapy for the whole face, as is the protocol used in my clinic.
Once Patient One’s skin was cleansed with chlorhexidine solution and the mesogun preloaded, 5ml of the protocol mixture was injected for a full facial treatment. It is always necessary to make sure that the patient is getting the product at the right skin depth. However, excess product will remain on the skin, which will be absorbed if enough time is allowed before cleaning the skin. According to Patient One, the treatment was not painful with the exception of the top lip area where the treatment was slightly uncomfortable.
The technique used during this facial treatment was ‘Nappage’. El- Domyati et al6 describe this technique as quick and linear injections at superficial or mid dermis (1-4mm). 6 The volume injected should be 0.1ml for each single droplet, at a distance of a few millimetres apart.
The treatment was finalised with the application of a recovery cream and a broad-spectrum sunscreen (SPF 50). No bruising was observed immediately post-procedure or in the days following the session. Once the treatment was finished, Patient One was advised not to wash her face for a few hours.
As per protocol, the treatment continued for a total of four sessions. All sessions followed the same preparation, technique, dosage and post treatment care as the first treatment. The sessions were booked every two weeks, and photographs were taken before each session.
Patient One reported after the first session that her skin had improved, exceeding her expectations, and she claimed she felt her skin was more hydrated. The greatest changes observed by both Patient One and myself were after the third and fourth sessions. Patient One described her skin as looking fresh and rested.
The last review session was four weeks following the final treatment. At this session Patient One reported that previously her skin used to feel fresh in the mornings, but due to the stress and nature of her job, her skin would start to feel dehydrated again by mid-afternoon; with the mesotherapy she was noticing a fresher look lasting all the way to the evening. For her this was a very positive outcome and one that she wanted to maintain.
Patient One was keen to maintain the results. My protocol for mesotherapy for hydration is to repeat this treatment every two to three months, depending on the condition of the skin. The skin is reviewed after two months, after which a treatment is scheduled accordingly, but generally is booked for the following month or earlier if required.
In my experience, the use of mesotherapy for skin rejuvenation and hydration is a highly effective treatment. This kind of approach will benefit the long-term health and look of the patient’s skin. Other advantages cited by Tosti and De Padova7 include minimal pain and very reduced incidence of complications, and the treatment can be performed on every skin type with less downtime compared with other aesthetic treatments (e.g. microneedling). Both the patient and I agreed the results on her skin had been favourable, consequently improving the patient-practitioner relationship/trust. With this in mind, aesthetic practitioners can confidently offer this treatment in clinic to maintain patient satisfaction.