Mesotherapy programs and patients with deformational type of aging

Vitoria Kopach, dermatovenerologist, head of the training center of the company “European Aesthetics - Ukraine”

Correctly determining the type of aging of the soft tissues of the face and neck is a very important component of professional success. And in this article we will talk about a program developed for patients with a deformational type of aging, which, according to many authors, predominates in the Slavic population (its frequency is approximately 62%).

However, I chose this topic not only because it is the most common and quite difficult morphotype for effective correction. Among many cosmetologists (especially those new to injection technologies) there is an opinion that it is enough to learn how to inject biorevitalization drugs and fillers - and success is guaranteed! But, colleagues, is this enough in the case of a deformation morphotype? Rather, these are procedures that will not even be indicated in this case!

Scale of deformation

So, the deformation type (large-wrinkled type, or “deformed face”) is characterized by a pronounced violation of skin elasticity, muscle tone, lymphatic drainage, and venous stasis. A change in the tone of the facial muscles will be characterized by the appearance of hypertonicity of the main muscles of the upper and lower third of the face along with hypotonicity of the muscles of the middle third of the face. Thus, among others m. are in a state of hypertonicity. frontalis (frontal muscle), m. procerus (proud muscle), m. depressor labii inferioris (muscle that lowers the lower lip), m. depressor anguli oris (muscle that lowers the angle of the mouth), and in a state of hypotonicity - m. zigomaticus major et minor (zygomaticus major and minor), m. orbicularis oculus (circular muscle of the eye), m. risorius (laughing muscle), m. buccinators (cheek muscle) and others. The consequence of this is a displacement of the musculocutaneous structures downward relative to the skeletal skeleton under the influence of gravity, and as a result there is a violation of the oval line of the face, overhanging skin of the upper and lower eyelids, the appearance of a double chin, the formation of deep folds and wrinkles (nasolabial and cervical-mental folds, wrinkles from the corners of the mouth to the chin). This morphotype of aging usually manifests itself in women with a dense build and a tendency to be overweight. Excess subcutaneous fat layer on the face also needs correction.

Depending on the severity of certain symptoms, this type is sometimes divided into three more subtypes:

• deformation;
• deformation-edematous;
• deformational-vascular.

Based on the diagnosis, an individual course of aesthetic correction of age-related skin changes is built.

Correction program: emphasis on meso

A course of aesthetic correction for this type of aging must necessarily include both adequate skin care and activities carried out in a beauty salon or specialized clinic (massage, hardware and injection procedures, peelings). You should also remember about recommendations for a healthy lifestyle, such as giving up bad habits, getting enough sleep, adequate physical activity, a balanced diet, in some cases normalizing weight, and treating concomitant diseases.

The mesotherapy part of the course will solve a certain number of problems:

• reducing tissue pastiness, using lymphatic drainage cocktails;
• reduction in the expression of subcutaneous fatty tissue in general on the face and directly in areas of local fat deposits (palpebral hernias of the lower eyelid, “jowls”, overhanging tissues distal to the “nasolabial” and “marionette lines”, double chin);
• the use of lifting cocktails to eliminate sagging skin;
• increasing the tone of muscles that have become hypotonic and using botulinum toxin preparations for muscles that are hypertonic;
• if necessary, the creation of a hydraulic reserve if the skin is deficient, and contour plastic surgery (once again, I note that this is the final part of the program).

The impact on the microcirculation system will necessarily include an impact on peripheral blood flow and lymph circulation (areas: spinal column, along the projection of the great vessels, problematic aesthetic area). Drugs used: lofton, fonziline, buflomedil, artichoke.

Reducing the thickness of subcutaneous fat

To achieve optimal effect, it is necessary to reduce the thickness of subcutaneous fat. For this purpose, it is good to use a cocktail containing L-carnitine and taurine.

L-carnitine activates metabolic processes, promotes optimal fat burning and energy release, and transports fatty acids in the mitochondria to the place of their “burning” and energy production. The basic formula looks like this: fat + oxygen + L-carnitine = energy.

Taurine, one of the main components of bile, helps emulsify fats in the intestines and improve energy and metabolic processes.

This cocktail is used once every 10–14 days and is indicated for administration to the level of subcutaneous fatty tissue. Recommended dosage – 1.5 ml. The technique used is classical, along the lines of Langer. The distance between injections is 0.7–1 cm. Course is 3–4 procedures.

We reduce the severity of local fat deposits

To do this, we use indirect lipolytics with a mild lipolytic effect. Indirect lipolysis occurs under the action of specific enzymes - lipases, or more precisely, by blocking these enzymes. Inhibition of phosphodiesterase is the point of action of indirect lipolytics.

Caffeine is a classic indirect lipolytic, which also has a metabolic effect, promoting the utilization of fatty acids.

Theophylline has a similar effect to caffeine, but much more pronounced.

Artichoke extract is an indirect lipolytic of plant origin. In addition to the lipolytic effect, it provides lymphatic drainage and choleretic effects.

A multipuncture infiltration technique to a depth of 0.4–0.6 cm is recommended. The dosage per injection is 0.1–0.2 ml. The recommended course is 3-4 procedures with an interval of 12-14 days. Injection areas: palpebral hernias of the lower eyelid, jowls, overhanging tissues distal to the nasolabial folds and marionette lines, double chin.

We tighten the skin and increase its turgor

This is the next task. And here drugs that increase hydration and provide antioxidant protection can (and should!) be involved. Complex biorevitalizants are unique in this regard.

The base substance is hyaluronic acid. This is a polysaccharide from the glycosaminoglycan family - an essential component of the intercellular matrix of the dermis. Hyaluronic acid stimulates physiological processes in the dermis and actively restores the structure of the intercellular matrix, which makes it possible to quickly strengthen the skin and increase its elasticity.

However, to achieve optimal results, a component is needed to tighten the skin and increase its tone. For this purpose, DMAE (dimethylaminoethanol) is used, a precursor of choline and acetylcholine. It activates the work of fibroblasts, stimulating collagen synthesis, which leads to tissue compaction. Externally, this is expressed as a tightening effect.

DMAE must be combined in a cocktail with amino acids that are very important for the construction of full-fledged collagen - L-proline, L-valine, glycine. Without them, it is impossible to build type 1 collagen, which makes up 70% of all fibrous structures of the dermis.

Working on muscle tone

Very important for the deformational type of aging, characterized mainly by changes in muscle tone, are procedures and techniques that restore the original state of facial muscle tone: microcurrent therapy, myostimulation, biostimulation, myolifting, etc. Injection techniques also show good results here. Not long ago, cocktails containing choline bitrate, which is also a precursor of acetylcholine, appeared. The use of cocktails containing DMAE is also effective, which, as a result of a chain of biochemical reactions, is converted into acetylcholine, which is necessary to ensure synaptic neuromuscular transmission and regulate muscle tone.

Recently, the effects that occur with intramuscular administration of choline preparations have been actively studied. In this case, an increase in the tone of the injected muscles is observed. Schemes have been developed for injecting facial muscles that are in hypotonicity: the lower portion of the frontalis muscle, the levator brow muscle, the lower portion of the orbicularis oculi muscle, the zygomatic major and minor muscles, and the levator labii superioris muscle. To achieve the effect, a course of procedures is carried out once a week, the course is at least 6 procedures. Injections are made deep into the muscle.

And only after all these stages it is logical to think about the final creation of a hydroreserve of the skin using the biorevitalization procedure. This should sound like the final note of our wise program score for the deformation type of aging.

First published: Les Nouvelles Esthetiques Ukraine, No. 3 (85), 2014