The use of mesotherapy in figure correction

Yulia Zlotnitskaya is a certified training doctor of the European Aesthetics – Ukraine company (Ukraine, Kiev).

Aesthetic medicine has a large range of tools that can effectively solve the problem of excess weight and local fat deposits. Of course, for effective therapy it is necessary to build a treatment plan for the patient, based on the etiopathogenetic concept - a combination of a healthy lifestyle with nutritional correction and treatment of vascular disorders. One of the leading methods in solving this problem is mesotherapy.

Today we can say with confidence that in the correction of excess weight, mesotherapy , i.e. chemical liposuction, is not inferior to surgical liposuction in its effectiveness. It is especially relevant when it comes to hormonally dependent areas, areas with genetically determined fat deposits. The methods used must be carefully followed by a doctor to avoid side effects.

In modern aesthetic medicine, numerous drugs with a pronounced lipolytic effect have been developed and are actively used. One of the leading drugs in this series is phosphatidylcholine.

Important lipolytic

Phosphatidylcholine is a representative of the group of phospholipids, discovered in 1847 by the French scientist M. Gobley. This substance is also known as “lecithin” (the word lecithin comes from the Greek lekithos - “egg yolk”, from where it was originally obtained). Phosphatidylcholine (PC) is naturally produced in the liver, is a component of cell membranes, provides their elasticity, and is the main substance of the nervous system - it accounts for about 30% of the weight of dry brain and 15% of the weight of nerves. PC and other phospholipids maintain the structure and permeability of cell membranes, which is necessary for cell life, the absorption of nutrients and the transfer of intercellular information, and are involved in the processes of fat metabolism in the liver. It has emulsifying properties, which allows it to dissolve triglycerides, preparing them for breakdown, prevents the formation of gallstones, and prevents the formation of cholesterol plaques in blood vessels by lowering cholesterol levels in the blood. PC is the main source of choline, a substance with high lipotropic activity. Tissues that use choline include the brain, kidneys, liver, and spleen. Choline stimulates the synthesis of its own PC and prevents excessive accumulation of fats in the liver, that is, it has a so-called lipotropic property. Choline is used by virtually every cell to synthesize various phospholipids, proteins and the neurotransmitter acetylcholine, which ensures optimal functioning of the nervous system.

Finally, PC plays an important role in the body's immune defense. It increases resistance to diseases: it helps to produce antibodies, stimulates the growth and activity of phagocytes (cells that surround and absorb viruses and microbes that invade the body). Thus, PC supports cellular metabolism, accelerates oxidative processes, ensures normal fat metabolism, helps produce energy, improves brain and cardiovascular function, promotes the absorption of vitamins A, D, E and K, increases the body’s resistance to viruses, microbes and toxic substances, stimulates bile secretion and the formation of red blood cells and hemoglobin.

Effective but requires attention

The anti-cellulite and lipolytic effects of PC are explained by its ability to stabilize the adipocyte membrane and increase the sensitivity of adipocyte receptors to lipolytic stimuli. It has been established that PC normalizes the metabolism of lipids and proteins, reduces the progression of cellulite, effectively slows down the development of fibrosis, accelerates tissue regeneration, and promotes retraction of the dermis. Its use as a lipolytic began with the treatment of xanthelasmas - localized intradermal fat formations on the eyelids or in the eye area, which are a manifestation of lipid metabolism disorders. Subsequently, the areas of application of PC expanded, and today there are methods for its use for various parts of the body.

It is important to remember that for the effective use of PC for the correction of cellulite and local fat deposits, it is necessary to strictly adhere to the protocol for using the drug. Errors and complications that arise when using it, in most cases, are the result of the negligence of aesthetic medicine specialists who neglect to carefully collect the patient’s medical history, analyze indications and contraindications, as well as adherence to the rules of drug administration, which have a number of differences from most mesotherapy cocktails.

Indications and contraindications

Indications for mesotherapeutic administration of PC include cellulite and local fat deposits, as well as correction of liposuction results (with uneven removal of fatty tissue). A mesotherapist can obtain very good results using FQ by using it in areas that are traditionally considered areas of problematic correction - the back of the thigh, the riding breeches area, fat deposits in the area of the seventh cervical vertebra - the so-called “menopausal hump”.

The list of contraindications includes general contraindications for invasive techniques: pregnancy, lactation, uncompensated diabetes, collagenosis, liver and kidney diseases, somatic, infectious diseases and others. It is necessary to pay attention to a thorough history taking. If a patient notes cases of allergic reactions to soy, then this is an absolute contraindication to the use of this drug, since soybeans are the source of PC used in medicine.

Features of the procedure

The highest single dose of PC is 500 mg. The drug may be administered no more than once a week. That is, we are talking about a single weekly dose of PC, exceeding which can lead to unwanted complications. It makes more sense to start therapy with the minimum effective dose – 100–150 mg of the active substance, which on average diluted PC at the rate of 80 mg per 1 ml is up to 2 ml of a mesotherapy cocktail. With each subsequent session, if the minimum dose is ineffective, it may be increased. The amount of mesotherapy cocktail administered with each injection should not exceed 0.2 ml. The injection points are located at a distance of at least 2 cm from each other. For optimal distribution of the drug, it is rational to arrange the injection points in a checkerboard pattern. PC should be injected strictly into the subcutaneous fat, perpendicular to the surface of the skin, using the infiltration method. When administering PC, you must first complete the injection of the solution by releasing pressure on the syringe plunger, and only after that remove the needle from the skin in order to minimize the appearance of the so-called “bump” drop. After completing the session, it is necessary to intensively knead the injection area in order to evenly distribute the mesotherapy cocktail in the subcutaneous fat. The patient must be warned that an inflammatory reaction will develop at the site of drug administration, accompanied by characteristic signs - swelling, erythema, pain, local hyperthermia. A number of patients report low-grade fever on the first day after the procedure. The recommended course of treatment is 4–7 procedures with an interval of 7 to 14 days, determined depending on the dose of the administered drug and the patient’s individual response to the procedure.

Necessary support

Therapy using PC must necessarily be accompanied by general vascular treatment. To obtain a highly effective result, it is necessary to conduct capillary mesotherapy of the area of the spinal column and the projection of large vessels of the extremities with vascular preparations in order to stimulate blood and lymph flow before administering PC. It is also mandatory to introduce lymphatic drainage massage into the lipolytic therapy regimen. Patients who are overweight tend to lead a sedentary lifestyle, the so-called “overweight lifestyle.” As a consequence of this, in such people up to 30% of the lymphatic vessels are in a “dormant”, inactive state, which significantly reduces the effectiveness of treatment. Stimulation of the blood and lymphatic beds will improve the evacuation of emulsified triglycerides and, accordingly, optimize the result of therapy.

Alone or in tandem?

Today, the method of introducing substances into cocktails that disrupt the integrity of the adipocyte membrane, such as sodium deoxycholate, is very controversial. Firstly, with the slightest violation of the rules for introducing cocktails, the risks of severe complications, in particular necrosis, are very high. Secondly, in most cases, our efforts to reduce the volume of subcutaneous fat are aimed at genetically determined areas, those where fat prevents hypothermia of organs important from the point of view of reproductive functions. In an effort to reduce the volume of subcutaneous fat in the abdomen and thighs, we can, in some cases, upset the physiological balance. If the colony of adipocytes is reduced to a critical minimum, then, as a compensatory phenomenon, the degeneration of stem cells, the so-called progenitor cells, into adipocytes may occur, which will lead to compensatory obesity. It is much more difficult to correct mesotherapeutically, due to the fact that compensatory adipocytes are more resistant to external influences. And it is not always possible to obtain satisfactory results using even such aggressive methods as the introduction of sodium deoxycholate, the introduction of a hypoosmolar solution by mesodissolution and others. Isolated administration of PC seems preferable, as it gives a completely satisfactory clinical effect.

In conclusion, it should be said that today PC occupies a leading place in the treatment of excess fat deposits. However, the results of its use entirely depend on the level of qualifications of the aesthetic medicine specialist conducting the therapy. With a competent etiopathogenetic approach to solving the problem, it is possible to achieve impressive results, including in areas of problematic correction.

First published: KOSMETIK international journal, No. 4(38), 2009