Mesotherapy useful for many conditions

San Francisco - Developed in France more than 50 years ago, mesotherapy has been slow to gain widespread acceptance in the United States.

Dermatologist Luigi L. Polla, M.D., director of the Forever Laser Institut in Geneva, includes mesotherapy - using a different methodology and different ingredients in the injections - for treatment of a number of conditions at his two medical spas. He has been performing the procedures for about six years and reports that patients are happy enough with the results to keep coming back.

Countering cellulite

According to Dr. Polla, mesotherapy works by breaking up fat deposits and is much more targeted than if the patient takes carnitine orally or if gels or lotions containing ingredients such as carnitine or theophylline are used topically. The following criteria apply to mesotherapy treatment for cellulite:

Depending on the products used, redness and edema should be gone in one day - although some redness may last up to two weeks, especially if phosphatidylcholine is used. Dr.Polla says mesotherapy works by breaking up fat deposits.

"Cellulite is not weight; it is a positioning of fat and an alteration of the conjunctive tissue that makes the skin look dimpled," he says.

"Mesotherapy for cellulite will make the skin smoother and will diminish the circumference of the thigh, for example. We consider good results to have a diminution of 1 cm to 2 cm around the thighs; same for the abdomen under the bellybutton."

Reviving the face

The idea behind facial rejuvenation, Dr. Polla tells Dermatology Times, is that collagen production is being stimulated through fibroblast activation. Mesotherapy criteria for facial rejuvenation are:

With proper technique - the right compounds injected at the appropriate depth - redness and swelling should not last more than 30 minutes. With products that diffuse slowly, it is important to inject a bit deeper and to avoid the formation of papules, Dr. Polla says.

Helping hair

Mesotherapy helps minimize hair loss and makes the hair look thicker in men and women suffering from alopecia or from hair loss associated with the aging process. The treatment does not regenerate hair growth.

Mesotherapy criteria for hair loss treatment are:

The only side effect may be a bit of bleeding, which would only last a few minutes after the treatment. Dr. Polla believes in using mesotherapy in combination with more traditional therapies - such as using Botox (Allergan) and Restylane (Q-Med) cooperatively for facial rejuvenation. Although he does not typically use topical anesthesia for any of these three modalities, he says that EMLA numbing cream (AstraZeneca) could be applied prior to treatment.

Critics of mesotherapy contend that some of the drugs, particularly phosphatidylcholine, can be unpredictable and can cause extreme inflammation and swelling when injected.

Dr. Polla responds, "Inflammation and swelling depend very much on the technique, rather than the compound injected. If you inject deep into the hypodermis, much less inflammation or swelling will occur because the hypodermis is a tissue that is less reactive than the dermis.

"Injecting less of the compound will also result in less inflammation and swelling."

Regarding the unpredictability of phosphatidylcholine, he says, "When it comes to cellulite, the results are indeed less predictable and reproducible than when using mesotherapy for rejuvenation, because cellulite is a more complex physiopathological state than photodamaged skin. Selecting the right patients is thus a greater challenge, and ... mesotherapy alone is not sufficient.

"For cellulite, mesotherapy alone will yield some results, but not optimal results unless it is combined with nutritional advice and exercise," Dr. Polla says.