Techniques for improving body contours

Natalya Mikhailova , Ph.D., dermatologist, cosmetologist, full member of the American Academy of Dermatology (AAD) and the American Society of Laser Medicine and Surgery (ASLMS), chief physician of the author's clinics "Reforma" (Russia)

Oksana Frolova, dermatovenerologist, cosmetologist (Russia)

What correction methods are the most popular and effective?

Non-invasive methods are offered to patients with a low pain threshold:

• external application of products (wraps, cosmeceuticals);
• manual techniques (lymphatic drainage, anti-cellulite massage, etc.);
• hardware methods (high frequency ultrasound, ultrasonic cavitation, vacuum massage, RF therapy, electroporation).

When using hardware techniques, the active components not only diffuse, but also penetrate into the dermis through skin appendages (hair follicles, ducts of the sebaceous and sweat glands), that is, through the transfollicular route. The conductor becomes a physical factor - electric current (electrophoresis) or ultrasound (ultraphonophoresis).

A relatively new method in cosmetology is electroporation (transmembrane route of administration). It is based on the phenomenon of temporary destabilization of bilipid layers under the influence of amplitude-modulated high-voltage electromagnetic pulses, which is accompanied by the formation of additional transport water channels (pores), through which hydrophilic substances of any molecular weight can penetrate.

As practice shows, when correcting cellulite and excess fat deposits (AFD), in addition to the active lipolytic effect, in order to obtain a maximum and lasting result, it is necessary to include in the program methods aimed at drainage and lifting, that is, we get the sequence “drainage - lipolysis - lifting”.

Drainage

It happens that cosmetologists neglect drainage techniques when correcting left eyelids and cellulite, and then wonder why they don’t have the result they expected. This issue is especially relevant when correcting cellulite, because one of the main links in the pathogenesis of cellulite is a violation of microcirculation, which leads to the formation of edema. According to the feedback principle, disruption of the outflow leads to disruption of blood flow, causing spasm of the precapillary sphincters of the arterioles. Under hypoxic conditions, hypertrophy of adipose tissue occurs. Therefore, it is logical to start the course with drainage therapy. Classic mesotherapy with the use of vascular drugs has proven itself well: ginkgo biloba, rutin, melilot, troxerutin, artichoke.

Ginkgo biloba is an arteriotonic, relieves spasm of precapillary sphincters, improving microcirculation and arterial blood flow into the treated area, has an angioprotective effect, reducing the permeability of the capillary wall. In addition to aesthetic use, it is also used for therapeutic purposes: for example, in patients with migraines and osteochondrosis, it helps relieve pain.

Rutin (rutoside) has angioprotective, anti-edematous, cytoprotective effects. It is used in drainage programs for the face and body, for the correction of rosacea and telangiectasia.

Melilot (clover officinalis) has venolymphotonic and drainage effects. Used in drainage programs for the body. It has proven itself well for varicose veins - it reduces swelling of the lower extremities and, as a result, relieves pain.

Artichoke is used for lipolytic and drainage purposes. Artichoke extract contains flavonoids, cynarin, organic acids, insulin, salts, vitamins and has a decongestant, diuretic and angioprotective effect. In addition, it has a choleretic effect, so it is worth using it in small volumes and provided that the patient does not have cholelithiasis.

Troxerutin (phleboside) has a powerful venotonic effect, reduces capillary permeability, and has an anti-edematous and anti-inflammatory effect.

With drainage therapy, it is recommended to begin a course of correction of the left abdominal cavity in areas of the so-called dense fat, when upon palpation there is tension, tissue density, and the skin is difficult to fold. Usually we are talking about several procedures (2-5) using drainage drugs as preparation for lipolytic therapy. After connecting lipolytic therapy, drainage drugs allow you to speed up the process of removing lipolysis products, since fatty acids, accumulating in tissues, can be deposited again in the form of fatty deposits. Since physical activity is not recommended after the mesoprocedure, the excretory system remains the method of removing water. To do this, the patient is advised not to forget to drink a sufficient amount of non-carbonated, unsweetened water (30 ml per 1 kg of body weight).

Lipolysis

Depending on the mechanism of action, lipolytics are divided into two groups.

Direct lipolytics act directly on the adipocyte, promoting the rupture of fat vacuoles (phosphatidylcholine, sodium deoxycholate). They are usually included in the course after drainage therapy. Direct lipolysis, as a rule, is accompanied by severe hematomas and pain both during the procedure and for several days after it. But the result is worth the effort, because direct lipolytics allow you to get a pronounced result.

Indirect lipolytics inhibit the action of the phosphodiesterase enzyme, which stimulates lipogenesis. Accordingly, with a decrease in its activity, the “lipolysis-lipogenesis” balance shifts towards lipolysis. Indirect lipolysis occurs more slowly, therefore, to enhance the effect of indirect lipolytics, they are recommended to be used in combination with drainage drugs and L-carnitine, which promotes the transport and beta-oxidation of fatty acids in mitochondria. Manufacturers of mesotherapy drugs take this into account and usually produce indirect lipolytics immediately in ready-made cocktails. This is convenient for a cosmetologist and allows you to use one cocktail throughout the entire mesocourse.

Lifting

After drainage and lipolytic therapy, the skin does not always have time to tighten to new volumes. This is an important point to consider and should be communicated at the initial consultation. Especially if the patient quickly loses volume or experiences an age-related decrease in tone. This is where mesotherapy with dimethylaminoethanol (DMAE) preparations will come to the rescue.

DMAE is a drug from the group of acetylcholine-like substances, an effective means for non-surgical tightening of soft facial tissues. Helps increase skin density and muscle tone, has pronounced anti-inflammatory activity.

Boxing on a colored backing

According to literature data on possible cytotoxicity at high concentrations, the percentage of DMAE in the cocktail should not exceed 3%. Lifting drugs are usually included in the course as needed, that is, as soon as a visible decrease in skin tone appears. The main technique for introduction when working with various areas of the body is deep nappage; for the face - medium nappage. When working with areas most prone to ptosis (abdomen, inner shoulder and thigh, area above the knee joints), as a rule, there is a need for skin tightening immediately after the start of the course, so DMAE preparations are used from the first procedure. And in areas of dense fat (thighs, buttocks), sagging skin may appear in the middle of the course (from the 7th–8th procedure).

Read the continuation of the article in Les Nouvelles Esthetiques Ukraine 2/2018