“Little, rarely, in the right place”: This well-known characterisation of mesotherapy by the ingeniously intuitive country doctor Michel Pistor still describes the therapy well today – more than 60 years after his discovery of the mesotherapeutic effect on a patient suffering from hearing loss. However, its importance for aesthetic medicine was discovered much later, namely when it became clear that in aesthetic treatment, the therapy (superficial introduction of the smallest dosages of regenerating active substances) and the target organ (middle [meso] skin layer) coincide.
Although there has been a dedicated mesotherapy department at the University of Bordeaux for decades, mesotherapy is primarily built on the experience of individual practitioners. Attending several advanced training courses, each user has different mixtures of active ingredients that he or she favours for a wide variety of clinical pictures, so much so that at one of the first mentions in aesthetic medicine, the editor of the Plastic and Reconstructive Surgery Journal, Rod Rohrich, spoke of the myth of mesotherapy, which he by no means meant positively at the time.
The Network Globalhealth, in particular one of its medical directors – Dr Michael Weidmann – has wrung a considerable amount of science out of this “myth” since 2009.
Indications of aesthetic mesotherapy
Aesthetic mesotherapy is suitable for two indications, both of which are linked to the skin in a very direct way, namely long-term improvements in skin status and hair loss. In both cases, the aim is to introduce tiny amounts of active ingredients into the skin of the affected regions in order to achieve a regenerative improvement in their status.
The treatment of the skin with mesotherapy
It should be mentioned at this point that mesotherapy is not only used “when the child has already fallen into the well”, but that it also has a very great potential in the prevention of the indications discussed.
In this respect, you can use it very well as an introduction to aesthetics. If you are younger, you can slowly approach aesthetic issues through mesotherapy. In the article on the ageing process of the skin, we had dealt in particular with light ageing and described this as an extrinsic factor (= acting from outside) of the skin ageing process. Mesotherapy used as prevention can slow down this process of skin ageing so that the formation of wrinkles starts later. This is an aspect that is becoming increasingly important in modern holistic aesthetics.
For which indications of the skin does mesotherapy show a good effect?
We have had far-reaching results with the indication elastosis. Skin damaged by sunlight and sunbeds can be regenerated very well – although not in a single treatment step. Another important indication is the reduction of pore size, which increases significantly in many people as they age.
A third indication can be well described by the term “pale complexion“, which can have very different causes. For example, the phenomenon called smoker’s skin comes to mind here. Overall paler skin structures with poorer blood circulation can be treated. In less damaged patients of this type, the phenomenon called “MesoGlow” can even be observed. Glow” is used here to describe a “radiant appearance“.
Some other skin conditions often respond to mesotherapeutic treatments, for example facial redness or age spots show good results.
In addition to the indications mentioned here, there is a wide spectrum in which mesotherapy is used synergistically in combination with other treatments or therapy options. We will therefore discuss these possibilities in a separate paragraph.
The treatment of hair loss with mesotherapy
The same applies to hair loss as to skin treatment. Here, too, correct adjustment is recommended. On the one hand, this concerns the right time of application. The Network Globalhealth / Network Aesthetics assumes that hair loss patients should first be treated with all procedures that are covered by the statutory health insurance. Another aspect is that the network initially limited its treatments to female patients because the genetic disposition to hair loss is much more pronounced in men and it does not want to raise unrealistic expectations. In the meantime, however, more and more young male patients are asking to be treated in the Network practices, despite the restriction that was made and also communicated to the patients. There is another restriction regarding the timing of the onset of hair loss. You can assume that up to 2 years after onset there are still inactive, non-destroyed follicles in the skin that can be stimulated to grow again by the therapy. If the therapy lasts longer than 2 years, the chances of success must be expected to decrease.
It is also important to determine the therapy goal for hair loss patients. An optimum would be achieved if the hair follicles can be reactivated and thus renewed growth is initiated. However, there are also less optimal improvements that can at least maintain the condition, namely to stop hair loss and strengthen the existing hair. Many patients are already satisfied with the latter option.
How does a mesotherapy treatment work?
- How often?
The low level of intervention (very minimally invasive) – this should be clear to you – involves repeated treatment until the desired improvement is achieved. As a rule, 8 sessions should be carried out in longer intervals: Session 1-4 in weekly or bi-weekly intervals and session 5-8 in monthly intervals. - How?
We distinguish between two ways of injecting skin or hair regenerating substances, which are used one after the other, the single-pulse mode and the nappage. In the single-pulse mode, individual injections with a low dosage are introduced at a defined depth at intervals of approximately 1 cm. We can assume that the more superficially the active substances are introduced, the longer they remain in the skin.
After the single pulse mode, the nappage is performed. Here, the needle is passed over the area to be treated with an even smaller dosage, similar to a sewing machine. This technique is very similar to needling and is intended to create an additional effect through the lesions (= mini injuries) that are set. Both techniques together result in an optimal treatment sequence. - With what?
For patient acceptance and also work efficiency, it is important to use the right tools so that the treatment can be carried out quickly and with as little pain as possible. Within the Network, work is mainly done with compressor guns. The gun recommended by the network is very fast, quiet and the forward movement of the needle without the syringe body enables an almost painless injection, which can penetrate very quickly due to the high compression pressure. The needles used are very fine, specially sharpened needles, which reduce the sensation of pain even further. - For how long?
For the preventive treatments and to ensure the success of the therapy in the long term, longer maintenance intervals of 3-6 months are necessary, in which the therapy should be repeated. - Suitable for whom?
Unlike botulinum toxin or filler treatments, for example, no immediate changes are seen with this regenerative approach. Patients who want quick success should opt for other, but therefore more invasive procedures. However, those who want to be treated gently, with a regenerative effect and rather holistically, and who are willing to accept a longer therapy period until successful and visible changes are achieved, respond very well to mesotherapy. - What is injected?
NWM-MesoLift for skin applications and NWM-MesoHair for hair loss treatment are two ready-to-use formulations developed by Network doctors. It is important to understand that both consist of one part each, which is called a catalyst. This term is understood in the mesotherapeutic context as an effect enhancer. The catalyst part is equally contained in both ready-to-use mixtures. The ingredients of the catalyst are: Multivitamins, silicon, rutin. MesoLift contains the following ingredients in addition to the catalyst: uncross-linked hyaluronic acid, dimethylaminoethanol (DMAE), Centella asiatica.
Results
In 2015, the Network Aesthetics developed statistics based on an evaluated questionnaire, the Meso-Report 2015, which evaluates the results of 13,878 treated patients. Through these statistics, 1,175 patients were recorded for the effect of the MesoLift. A much larger number, namely 12,500 patients, was the basis for the evaluation of the hair loss treatments. Fig. 2 and shows the evaluation of the results by those of the patients.
Results of the member survey on aesthetic mesotherapy
Red – less satisfied; blue – satisfied; green – very satisfied.
Contraindications and risks
As can already be seen from the very minimally invasive degree of intervention, the therapy has few side effects and complications when used correctly. The network actually sees only one real risk, namely that of an allergic reaction to one of the active substances used. It therefore recommends the exclusion of multi-allergy sufferers from the outset in order to minimise this risk.
Absolutely contraindicated are also pregnancy, intolerance or allergy to an active ingredient, tendency to hypertrophic scars or pigment disorders, strongly active autoimmune processes, severe cardiovascular or metabolic disorder, acute viral or bacterial infections, acute inflammatory dermatoses, epilepsy.
Relatively contraindicated are psoriasis, neurodermatitis, bleeding and clotting abnormalities, herpes (patients with a tendency to herpes should be given herpes prophylaxis before treatment), dysmorphophobia syndrome (body perception disorder).
Combinations
In the course of the last few years, synergistic effects of mesotherapy with other procedures have been discovered more and more frequently. In some surgical clinics, for example, all patients who are operated on by a plastic surgeon are treated with mesotherapy at least twice beforehand. The improvement in wound healing is clear.
The combination with needling has proven to be particularly good. Acne scars and small wrinkles can be treated very well in this way. In preparation for the thread lift, the combination with mesotherapy is also recommended. The regenerative effect of the threads is further increased by previous MesoLift treatments. In the case of hair loss, the effect is also increased by combining it with PRP (“platelet rich plasma”) therapy (= treatment with a proportion of the patient’s own blood).
Concluding words
Although many other treatments can be carried out, especially with lasers, in order to achieve positive skin changes, in the view of the network there is no better alternative for the indications described. However, this is under the condition that the patients accept several sessions until optimisation is achieved. In the future, the Network will focus on investigating not only statistical and qualitative scientific evidence, but also the more difficult quantitative improvements.