Mesotherapy and oxidative stress

Valeria Kosova , dermatologist, cosmetologist, founder of the medical cosmetology studio Boss Of Beauty (Ukraine)

Mesotherapy in cosmetology has existed for about 35 years: in 1987 it was recognized by the French Academy of Medicine, and practice in this area is also allowed. Among scientists and specialists, the effectiveness of mesotherapy does not raise questions. But patients have an ambiguous attitude: there are those who are not satisfied with the result of this procedure or have received undesirable effects that are not always amenable to complete correction.

Where does this imbalance of opinions come from and the eternal division of patients and doctors into different camps by a barricade of misunderstandings?

The effectiveness of mesotherapy depends not only on the drug, but also on the characteristics of the patient’s body and the qualifications of the mesotherapist who is able to assess the situation, needs and clinical picture for the correct choice of mesotherapy and the technique of its administration.

Mesotherapy is a method of administering medications intradermally in small doses, both locoregionally and in the area near the affected organ. The goal is to obtain a pharmaceutical effect and a stimulating effect of tissue puncture. Patients and cosmetologists themselves distinguish mesotherapy separately from biorevitalization, redermalization and other injections of drugs with a viscosity and release form different from ampoules and bottles. From the technical side, this is not entirely true, since all this is nothing more than the introduction of active components into the dermis and subcutaneous tissue using a needle for the purpose of prevention and treatment of aesthetic defects of the skin and other soft tissues.

The influence of mesopreparations

All therapeutic injections (as opposed to “beauty injections” such as botulinum therapy, filling with hyaluronic acid, calcium hydroxyapatite, etc.) are expected to have effects such as punctuation, pharmacological and neurohumoral. It is worth emphasizing that the pharmacological effect is only one of three, and not the only one or even the main one. Without understanding this important point, patients and cosmetologists are doomed to waste time, reading well-written (often with the participation of a marketing team) protocols for the use of mesopreparations, placing great hopes on a new “miracle remedy” and being disappointed in attempts to obtain the effect of an “elixir against age-related changes.”

The neurohumoral effect is profound and has much in common with the principles of acupuncture. In short: after puncture of a certain area of skin, blood circulation in target organs improves (for example, the effect of capillary mesotherapy). According to the axon-reflex mechanism, endorphins are produced - signaling molecules that ultimately lead to a response from the central nervous system, cardiovascular system, and nervous system.

Impact of a needle on the skin

I would like to dwell in more detail on the punctuation effect. It is based on puncture of the skin, formation of a wound channel and provocation of aseptic inflammation.

What happens in tissues after drug administration

Even if we puncture with a “dry needle”, without introducing a meso-cocktail, completely excluding the pharmacological effect, we will form a wound channel and, as a result, inflammation with all its necessary components: alteration (damage to the skin with a needle), pain, swelling and redness. This is the basis of the operating principle of various mesoscooters, dermastamps, etc.).

As a result of edema that forms as a result of plasma exudation, as well as the release of plasma proteins and blood cells into the intercellular space, conditions are created for tissue hypoxia. This leads to the formation of their breakdown products, and then the production of histamine, serotonin, nitric oxide and free radicals occurs. Thus, we use most mesopreparations to combat what is necessarily formed during the procedure itself. Let me remind you that free radicals are capable of performing certain functions (this was discussed in the article “Oxidative stress and invasive procedures” ).

Local reactions during mesotherapy

We present a brief diagram of the healing of a wound channel made with a sterile needle without scar formation. And it is possible only if the skin has sufficient resources:

1. In response to a cascade of reactions caused by a violation of the integrity of the skin, fibroblasts are activated, growth factors, acid mucopolysaccharides, collagen and elastin fibers are produced (the question of the possibility of the formation of new elastin fibers is controversial).
2. Next, neoangiogenesis and normalization of tissue structure are activated.

With intense work of antioxidant and other skin systems and/or with sufficient strength of the administered drug, neutralize not only existing, but also free radicals newly formed after the procedure.

In addition, vitamins, when introduced into the skin, are almost instantly absorbed into the blood and are no longer able to have a pronounced local effect. In the opposite case, healing occurs with the formation of scar tissue, which prevents adequate blood supply and lymphatic drainage to the tissues. Clinically, this manifests itself in the formation of a symptom complex corresponding to the skin of a smoker - “parchment skin”, enlarged pores, earthy color, rough pattern of wrinkles, etc.

Recommendations for an effective procedure

Considering all of the above, when choosing mesopreparations and methods of their administration, it is advisable to adhere to the following recommendations:

• When intradermal administration of drugs aimed at combating free radicals, it is important to use products that have sufficient viscosity to form a depot of antioxidants in the dermis. They will be gradually released, exhibiting their local effect, most often these are various bio- and redermalizants, skin boosters, preparations with polydeoxyribonucleotides, etc.;
• if a specialist chooses an aqueous mesococktail, it is better to consider the option of hardware administration, for example, using electroporation or galvanic currents;
• It is important to understand that the non-injection method can only introduce very low molecular weight components of very small sizes, which does not include even the lowest molecular weight hyaluronic acid.

As for the effect of mesotherapy, it can become noticeable years later, since this direction is more preventive than therapeutic.

It is important to explain to the patient that preventing age-related changes is much more important and easier than treating existing ones, and mesotherapy is one of the most important stages, without which it is simply impossible to grow up beautifully, without signs of hypercorrection.