Download - mesoterapia
Dr. Michel Pistor “1952”
• Non surgical relatively painless technique that
is used worldwide with a broad range of
indications (rheumatology, sports, vasc.
Diseases, pain relief, ….)
• It is a technique of using microinjections of
conventional or homeopathic compounds
(A.A., vitamins, minerals,….) to deliver a
healing or corrective treatment to a specific
area.
Dr. Michel Pistor (1924-2003) performed clinical research and founded the field of mesotherapy.
Multi-national research in intradermal therapy culminated with Pistor's work from 1948 to 1952 in human mesotherapy treatments.
The French press coined the term Mesotherapy in 1958.
The French Academy of Medicine recognized Mesotherapy as a Specialty of Medicine in 1987.
Popular throughout European countries and South America, mesotherapy is practiced by approximately 18,000 physicians worldwide.
Definition:
(From Greek mesos, "middle", and therapy from Greek therapeia, "to treat medically")
It is a non-surgical cosmetic medicine treatment.
Mesotherapy employs multiple injections of pharmaceutical and homeopathic medications, plant extracts, vitamins, and other ingredients into the subcutaneous fat.
Mesolift (mesoglow)
Mesobotox
Mesohair
Mesocellulite
Mesomelasma
•Mesostriae
•Mesofat
Body
Double chin Eyepad fats
Face
Polyvitamins, antioxidants, H. A.
Activate cell metabolism
Mechanism of action 1.Activation of fibroblast activity
2.Replace loss of H.A.
3.Improve cellular metab. & circulation
NB: inactive circulation
Repair age related skin
damage
Tardy supply of nutrients
Acc. of waste products
1.Right drug
2.Right dose
3.Right location
Compound Characteristics
Vitamins Vitamin A
Regulates keratinocyte activity, promotes collagen synthesis
Vitamin B Regulate the biological balance of the skin
Vitamin C Stimulates collagen synthesis, inhibits melanin synthesis, is an antioxidant
Vitamin D Takes care of essential calcium synthesis and cell membrane stability
Vitamin E Generates ant-radical activity and improves the microcirculation
Vitamin K Provides an important substance in skin microcirculation
Amino acids Promote protein construction
Minerals (sodium, potassium, calcium and magnesium)
Provide ionic balance
Coenzymes Serve as biochemical catalysts
Nucleic acids Synthesize proteins
1.Intraepidermal (0.5-1 mm) the most superficial
2.Papular technique (dermoepidermal J.)
3.Nappage (2-4mm) (30-60 )
One syringe to inject several times continuously
into dermis
4.Point by point
Single injection (1-2 cm apart) micropapules
1.Once/week 4 ws
Once/2ws 2 months
Once/month 2 months
2.One ttt/14 d 2 months
3.One ttt / 6-8 ws 3 months
Maintenance every 3-6 months
1.Pregnancy
2.Insulin dependent diabetes
3.History of strokes
4.History of recent cancer
5.Thromboembolic phenomenon
6.Medications (warfarin, heparin, NSAI)
1.No needle cutting, no operative intervention
2.Low dose usage, precise location
3.No complication to any part of body
4.Time release absorption
but the transepidermal penetration: Why not simply rub the product topically on the skin surface ?
The most important is NOT
the technique (Manual-gun-nappage-point by point …)
No Needle Mesotherapy
Interwaved Modulated Radiofrequency
(IMRF)
Alternative to traditional mesotherapy
No needle
No pain Efficient
Reliable
Electronic
impulses
High frequency
Permeabilising cellular membranes
(altering membrane potential)
Electroporation of lipids bilayer
(biological stress)
Low intensity
• There is no electronic contact with the
patients. So there is no risk of chemical
burns, pain or inflammation.
• It is not invasive
• It has no return electrode (ground plate)
• It is not contraindicated in prosthesis
• There is no molecular ionization of the
transported substances
Advantages over other transdermal
transport techniques or systems:
• It is valid for ionic, non-ionic and lipidic
substances
• The speed of transcutaneous penetration of
the hydrolipid products is approximately 1
gram per 60 seconds
• It does not require any conductor gel
• It has no secondary effects
• Practical, transportable and easy to handle
• It introduces substances of any molecular
weight
Advantages over other transdermal
transport techniques or systems (cont.):
Indicated in:
•Obesity
•Cellulite
•Flaccidity
•Facial treatments
•Stretch marks
Electroporation by radiofrequency is a very
reliable techniques which can be adapted to
multiple therapies and opens up the way to
numerous possibilities.
Contra indications
•Patients with pace makers
•Pregnant women
•Severe acne
•Epileptic patients
Phosphatidyl
choline Deoxycholate
Rittes PG. Dermatol Surg. 2001. 27:391-392. Improvement of lower lid
bulging due to prominent fat pads (250mg/5mL)
• Hexsel D. J Drugs Dermatol. 2003. 2(5):511-518. Improvement of adipose
deposits following liposuction (250mg/5mL)
• Rotunda AM. Dermatol Surg. 2004. 30(7):1001-1008. Active component -
detergent effect ofsodium deoxycholate.
Localized fat deposits are areas where fat is accumulated and does not disappear with diet and exercise. They are found at the face, jowl, neck, arm, abdomen, back, thigh and hip areas.
They can be aggravated by the aging process, hormonal changes, poor dietary habits, lack of exercise and slow metabolism conditions.
Fat cells are metabolically active and are well supplied by blood vessels.
The fatty acids come from 3 main sources: 1. Dietary fats. 2. Fat produced in the liver. 3. Excess blood glucose. There are two types of fat; Brown fat and white fat. A fifth to a quarter of adult body weight is made from
white adipose tissue.
Brown fat assist in burning energy / calories, generates heat and appears as small lipid droplets.
White fat is the conventional type of fat which stores energy and is full of lipid droplets. White fat is always beneath the skin and is the cause of obesity.
Adipose tissue is the largest storehouse of energy in the body (in the form of triglycerides) and makes up 15-20% of the body weight in men and 20-25% of body weight in women.
Men are more likely to get "potbellies" because their fat is stored around the abdomen, whereas women tend to get heavier hips, thighs and rear ends.
Hormones cause the deposition of fat in specific areas of the body.
Aging process slows down metabolic rate, allowing fatty tissue deposits.
Poor dietary habits and sedentary lifestyle.
Genetic.
Patients with small localized fat deposits.
Patients not suitable for operations.
Patients aware of mesotherapy.
Phosphatidylcholine.
Na deoxycholate.
Caffeine.
Vitamins and anti-oxidants.
Ma huang herb ( ephedra).
L-carnitine.
3-6 sessions at 2-4 weeks interval. 250mg of phosphatidylcholine (250mg/5mL) injected into effected area. Patient can be seated or lying down Better to measure diameter of area to be treated before session. Anesthesia ( optional and local ). Sterilization with alcohol swap. Multiple injections with a 10 -12 mm long needle ( to reach subcutis). Injections given at 1-2cm. Interval. Takes from 10-15 min.
All patients asked to follow a natural healthy diet.
Lots of water is used to flush toxins that are eliminated from the body along with dissolved fat.
Exercise is needed to circulate the medications used, with either walking or another form of aerobic activity, three times a week.
Local anti-inflammatory may be used twice daily for bruising, irritation and discomfort e.g. reparil gel.
Bruising.
Redness, irritation and itching over the injected area which may last to 3 days post session.
Edema :
Traumatic from injection.
Lipolysis.
Post-inflammatory hyperpigmentation.
Hematoma formation.
Patient dissatisfaction.
Pregnancy.
Lactation.
Diabetes mellitus.
Bleeding tendency.
Psychic patient.
Children.
Generalized obesity.
Targeting weight reduction.
2-4 cm decrease in the diameter of the injected part 2 weeks after the session.
No weight loss.
Right patient selection …. Optimum results.
What to Expect :
Surgical Procedure Removes fat cells Cannot be used where
cellulite is 2 weeks down time Wear restrictive garments for
weeks Weight gain back in extra-
treated sites. Significant bruising and pain Causes scarring Takes up to 3 months to see
results Causes loose and weak skin
places
Non-invasive procedure Removes fat from cells Used wherever there is
cellulite No down time Wear loose clothing after
treatment Weight gain back where it
was Minimal bruising and pain Reduces scarring Results seen in weeks.
Tightens and strengthens skin .
Phosphatidyl choline has been recently tried with
variable results.
L-carntitine aslo has been tried .
Cellulite is an accumulation of fat, fluid, and toxins trapped in a hardened network of connective tissue fibers that hold down the skin causing the "dimpling" effect.
The fat cells inflate, causing a rippling and puckering of the skin, commonly referred to as orange peel skin.
Lymphatic and venous circulation are poor in these areas.
Mesotherapy is used to cause an increase in venous and lymphatic flow, as well as elimination of fat and dimpling in the area.
The medications used in Mesotherapy destroy the connective tissue bands and melt the trapped fat, creating a smooth, dimple-free appearance.
Patient who is seeking treatment for cellulite
Possibly overweight, but not obese
Not interested in surgery
Wants a fast, easy, procedure that shows good results
Treatments will depend on how much cellulite and dimpling the patient has in the problem area.
Treatment can last 15-45 minutes.
Involves injecting several small amounts of medications and vitamins into the middle layer of skin.
Optional anesthesia.
Isoproterenol (β-Agonist)
Hyaluronidase, collagenase
Ephedrine (Sympathomimetic amine)
Calcium pyruvate (Kreb’s cycle metabolite)
Carnitine (amino acid derivative)
Ma huang herb ( ephedra)… Fat burner; is inhibited for systemic use in
USA.
Gingko biloba extract … platelet aggregation factor inhibitor, endothelium
derived relaxing factor .
Artichoke ( circulatory stimulator)
Improved blood flow to the treated area.
Dissolves excess fat deposits.
Removes fibrotic, hardened connective tissue.
Improved lymphatic drainage.
No downtime.
No downtime procedure.
The treatment is permanent and the results are measurable as long as patients do not gain more than fifteen pounds.
Most people will require from 6-10 sessions to achieve results at 1-2 weeks intervals.
Dieting and exercise will help to maintain one's results over the long term.
In 4 weeks, a patient's skin appears significantly smoother.
Most patients lose anywhere from 2-4 inches where their
cellulite is treated.
Injection-Lipolysis
World Map, Robinson Projection
NETWORK-Lipolysis
NETWORK
Injection-Lipolysis
Europe
Asia North America
Africa
Australia/ Oceania
South America
An international association of physicians in all fields with at present exceeding 2900 physicians
from 64 countries applying Lipolysis injections
according to the NETWORK’s method.
Injection-Lipolysis
Definition
Definition of Injection Lipolysis
Lipolysis is used for the Reduction of small localized fat
deposits
by destroying the adipocytes structure.
It is performed by subcutaneous injections
with a solution of polyenyl-phosphatidylcholine
and the solvent deoxycholic acid, a bile acid.
Injection-Lipolysis
vs Mesotherapy
Terms
• Lipolysis:
SUBcutaneous injections, depth 6 mm – 12 mm subcutaneously
injected into fatty tissue! Only to dissolve fat! Aesthetic use!
• Mesotherapy: INTRAcutaneous injections, depth 1 mm – 4 mm intracutaneously
injected to cure hundreds of diseases by injecting small amounts of a variety of mostly homeopathic substances (200 different agents and more are known).
(Dr. Michel Pistor, France 1952)
Lipolysis vs. Mesotherapy
Injection-Lipolysis and Mesotherapy are entirely different techniques!
PC in
Aesthetic medicine
Italy 1988
• First official aesthetic introduction on the 5th International Meeting of
Mesotherapy in Paris, first treatment of Xanthelasmas (light-yellow fat
cholesterol deposits of eyelids) – in Italy by Sergio Maggiori M.D.
Brasilia 1995
• First treatment of lower eye fat pads (Dermatologist Patricia Rittes M.D., Brazil)
Europe 2001
• First experimental and clinical studies beginning
Europe 2002
• First case reports by Franz Hasengschwandtner M.D. (Austria) and
beginning of treatments
Europe 2003
• Foundation of „NETWORK-Lipolysis“
• Development of a standardised training concept
Europe 2004 • Establishment of research groups. • Development of a new treatment protocol
1988 2004
PC in
Aesthetic medicine
Worldwide 2004
• Establishment of worldwide NETWORK-Representative
• „1. International Lipolysis-Congress“ and NETWORK member meeting,
FFM
Worldwide 2005
• Foundation of “ISL – International Society of Lipolysistherapy“
Websites for patient information in 8 languages
• Publishing 2nd NETWORK-Lipolysis Report 2004“
• Studien-Kooperation mit der Ruhruniversität, Bochum
• 1. International Lipolysis Convention in Salzburg, Austria
• 2. International Lipolysis Congress and NETWORK member meeting in
Paris
Europe 2006:
• Third party liability insurance for NETWORK-Members in EU, Norw. & CH
• Start Scientific NETWORK-Compound Study, University of Regensburg, GER
• 1. International Scientific Symposium on Injection-Lipolysis, Vienna
• 3. International Lipolysis Congress and NETWORK member meeting in
Vienna
• Statistic surveys in UK und USA
• Studies of members in Universities of Cairo & Roma
2004 2006
PC in
Aesthetic medicine
Worldwide 2007
• Study of Lipoma treatment by member Dr. Bechara, Ruhr-University,
Bochum
• 1. M.A.S.T.E.R.-Conference 2007 and NETWORK member meeting in Paris
• 1. NETWORK Austral-Asean Lipolysis member conference in Sydney
Worldwide 2008
• 12 Compound Pharmacy (EU, AUS, USA, CAN, MEX, EGY, ISR, SA,
KUW, LEB, VRC, Dubai) produce standardized NETWORK Compound in
high quality
• 1. National German NETWORK member meeting
Worldwide 2009
• Expanding 3rd party liability insurance for NETWORK-Members
worldwide (except USA)
• 2. M.A.S.T.E.R.-Conference 2009 – FAT and NETWORK member meeting
• Introduction of the new NETWORK Compound Mixture
Worldwide 2010
• Introduction of the new NETWORK Pain & Side Effect Management
Worldwide 2012
• 3. M.A.S.T.E.R.-Conference June 11th 2012 – Majorca
2007 2010
PC - DC
Dosages
Used dosages in application of
PC
0 5 10 15 20 25 30
Fat embolism
Atherosclerosis
Bipolar depression
Colitis Ulcerosa
Lipolysis 2.5
4.5
2.5
15 15
6
Lipolysis 8 weeks subcutanous
Intravenous daily in gr.
Oral daily in gr.
PC - DC
Composition
Biochemistry and Function
LIPIDES ( Fatty acids and derivates )
and classificated
in 2 groups
STORAGE-LIPIDE MEMBRANE-LIPIDE
Triglycerides Phospholipide and Glycolipide
Phosphatidylcholine (PC) / Lecithine is an essential phospholipid
Phospholipids Phosphatidylcholine is an essential Phospholipid (in literature also mentioned as EPL), which is specially high concentrated in membrans of adipocytes and Hepatocytes.
Sphingomyelin (70/30 %), another important phospholipid, is highly concentrated in nerves and brain. It has a different composition in comparison with PC, being esterified with Ceramid-1-phospate to long chained fatty acids.
This leads to a resistance of nerve
tissue
against the detergent effect of
medications
used for injection-lipolysis
procedures!!
PC - DC
Composition
PC - DC
Function
Cell membrane destruction If we speak of injectable PPC we always
have
3 basic components: Bile acid as solvent preservative
Deoxycholate (2,44 %) Benzyl alcohol as Phosphatidylcholine (5 %)
PC
DC
PC - DC
Function
Emulsion – Lipases - Metabolism
bursting of the adipocyte‘s membrane - The deoxycholate in PC/DC
liquifies and dissolves the plasma membrane.
emulsification of fat by detergent effect of the active ingredients and
transportation into the liver by HDL particles and by micelle formation.
It follows a partial degradation by a cascade of enzymes (hormone
sensitive lipase, triglyceride-, diglyceride-, monoglyceride-lipase), and
a further metabolism/catabolism in the liver, among others by ß-
oxidation in the mitochondria (in citric acid cycle).
The lipolytic process
- a hypothesis
PC/DC - lecithine
Adipocytes before and after treatment with PCDC
solution (University of California Los Angeles, Division of
Dermatology, in vitro)
Publication: Adam Rotunda, Dermatol. Surg 2004;30:1001-1008
The lipolytic process
The lipolytic process
- a hypothesis
In vivo lysis of adipocytes
Photos: Dr. Hasengschwandtner
10 days after lipolysis
Adipocytes
Membran destruction
Emulsification
Transportation into the liver
Metabolism
The lipolytic process
- a hypothesis
PC injection
The most important
steps in dissolving the
subcutaneous fat!
The lipolytic process
Dissolving the subcutaneous fat
1. bursting of the adipocyte‘s membrane -The deoxycholate in
PCDC liquifies and dissolves the plasma membrane.
2. emulsification of fat by detergent effect of the active
ingredients and
3. breakdown the fat through enzym cascade
4. transportation into the liver by HDL particles and by micelle
formation. It follows a partial degradation by a cascade of
enzymes (hormone sensitive lipase, triglyceride-, diglyceride-
, monoglyceride-lipase)
5. a further metabolism/catabolism in the liver, among others by
ß- oxidation in the mitochondria (in citric acid cycle). The
final products of degradation are C02, H2O and energy.
proven by science
NETWORK Study
Univ. Regensburg
Cell Damaging Effects of Na-DC propidium-jodid-stain ( DNA intercalator for the stain of necrotic cells)
(Univ. Regensburg)
Scale bar: 20
µm Effect @ 0.05 mg/ml, Lipolysis 12,5g
1% Triton
X
4 h
Na-DC
0.01
mg/ml
4 h
Na-DC
0.05
mg/ml
4 h
Na-DC
0.1
mg/ml
4 h
Control
4 h
Viability decreases @ 0.5 mg/ml (Univ. Regensburg)
0
20
40
60
80
100
120
Cell v
iab
ilit
y [
%]
Na-DC [mg/ml]
Cell Viability after Treatment with Na-DC
NETWORK Study
Univ. Regensburg
MTT-Assay: = Thiazolyl blue tetrazolium bromid quantitative photometrical determination of cell number and metabolicactivity
The amount of form is proportional to number of living cells
PC - DC
Safety Safety for patients and physicians
Do not use PC of inferior quality!
10 different PC raw materials (Soy, chicken eggs, synthetics) different qualities for injectable PC Only high quality Soy lecithine is successful in lipolysis PC is produced in different countries • sometimes raw material quality is wrong • sometimes the PC/DC ratio is wrong. • some products contain only 30% of the necessary PC
concentration. NETWORK led laboratory tests of most common PC products.
• Some contain a too high concentration of Lyso-PC Most products are not to be uses successfully for
subcutaneous lipolysis.
NETWORK recommends only 2 commercial products: Lipobean (S.Korea), Essentiale® N (Ukraine – licensed from Germany).
Lyso-PC
Comparison
Products
•Toxic over a concentration of 9%
•High concentrations of Lyso-PC result from wrong production procedure
•NWL-1 content: < 3.0 % Lyso-PC
•Some products have Lyso-PC concentrations of of over 17%
PC products by lab comparison
PC - DC
Comparison
Product name PPC concentration
(mg)
Lyso-PC concentration
Lipostabil 254 5,71 %
NWL 1 259 1,51 %
Formula magistralis 228 4,84 %
Not Lipolysis suitable > 9% = toxic
Dermastabilon 76 9,21 %
BCN Phosphatidylcholin 77 12,26 %
Inno-Med 78 8,92 %
Mesoline 82 9,70 %
Toscani Phosphocol 110 8,18 %
Benefit / Risk ratio
PC/DC
Benefit/risk ratio
Less
PC
High concentration DC
High concentration Lyso-PC
Significant increase of side-effects
Significant decrease of effects
Patient selection
Criteria
The treatment – successful or not? Psychological components
Patient selection
Criteria
Different types of fat tissue
Excellent to treat:
Soft fat = „pudding fat“ You must see it with your
fingertips!
Less successfully to be treated:
Firm, tough fat, it contains a lot of binding tissue
Region is secondary, consistency is important!
Patient selection
Criteria
Don't let yourself be persuaded by the demands of patients to do non-promising treatments. Patients often are very challenging!
Pre-select carefully if suitable and do not promise too much
Results of facial procedures often are very satisfying
Sometimes the treatment of inner thighs is more important than the lateral parts of the thighs.
Be aware that good results with saddlebags can only be achieved if they consist of soft and gentle fat. Very tight and substantial ‘rubbery’ fat-tissue is stubborn and has a less good prognosis
Treat obese persons only with respect to the fact that lipolysis can only be an additional help for their weight-problem.
Cooperation with an plastic surgeon has proven to be very satisfying for both parties.
Pearls Most important: The pre – selection of patients
Patient selection
Criteria
Treatment combinations
Combination Lipolysis and Liposuction
Lipolysis before Liposuction – ca. 10 days
Lipolysis after Liposuction – corrections
Combination Lipolysis and Diet
Lipolysis during weight reduction
Patient selection – selection possibilities
Patient information
NETWORK files
Patient information
1. Patient information about therapy
2. Anamnesis sheet: patients have to fill out the form accurately.
3. Risk information: record the individual information by hand made
signatures or grafics
4. Precaution
1. 14 days befor treatment patient should stop using blood thinning medication
2. Body treatment: patient should wear width clothes on day of treatmet
3. Woman: Do not treat during menses because
of higher pain level.
5. After care
1. Explain Pain & Side effect Management (PSM)
2. What to do after treatment
Patients must be informed very precisely
Contra indication
Absolute
• Minors or children
• Pregnant women; Nursing Mothers
• Diabetics with microangiopathy or patients with other perfusion disturbances.
• Certain autoimmune diseases (Scleroderma, Pemphigus vulgaris, systemic lupus erythematosis,
dermatomyositis
Not contraindicated are: Rheumatic illnesses and thyroiditis Hashimoto
• Severe liver diseases (cirrhosis, carcinoma)
Contra indication
Relative
• Renal diseases
• (short-chain fatty acids are eliminated via the kidneys)
• Lipodystrophy
• Disturbances of blood coagulation
• Inflammatory connective tissue diseases
(Polymyositis, Dermatomyositis)
• Acute infections and chronic infection risk (Tuberculosis, HIV patients - clinical study: bull-necked HIV
patient)
• Severe allergy history and known allergies against used substances contained in the
injections (f.i. Benzylalcohol, VitE, VitB in the Compound - very rare allergies)
• Malignant obesity
Local irritations 1-7 days
Redness
Itching
Swelling
Up to 2 weeks
Pain in the treated
area
Haematoma (bruises)
Miscellaneous
Sensitivity to the
touch
- up to 3 weeks
Nodules
(deep Haematomas
sometimes appear as nodules
not disappearing for longer
period of time.
Rather rare occure fibromas if
injected too deep.
Hyperpigmentation – up to 3
month
Side effects
Necessity of thorough Patient Information
Hyperpigmentation after injections may occur
Side effects
post injection
• Hyperpigmentation occurs quite rarely and disappears commonly after three months.
• Laser treatment is contra identicated
Side effects
Exceptions
Rare Reactions Exceptions
• All facial treatments may be accompanied by obvious swelling and
uncomfortable sensations (oedema and erythema); they may last
for up to one week (cheeks; double chin; neck)
Rare Reactions
• Infections which can appear after any injections (never seen)
• Slight cholinergic reactions
• Increased stool frequency or mild diarrhoea
• Circulatory problems for a short time after injections –
• hypovolaemia, low BP (night time collapse)
• Intermenstrual menorrhoea
• (fatty tissue is a high oestrogen accumulator)
Side effects
After 24 hours
Jowels and double chin (neck)
Before – 24 hours after injections – after 8 weeks.
Photos: Dr. Hasengschwandtner (A) Pat.6711
24 hours after first injections Before After 8 weeks
Side effects
Attention!!
Inject with special care
Lipolysis post Liposuction: the areas coult be altered fibrous with insufficient blood flow. Danger of necrosis on areas with less micro circulation.
Beware of injecting into tendons, ligaments and bursae – f.e. around knee and tendo Achillis.
Decontaminate skin thoroughly before injecting to avoid infection and abscess formation
Fibrotic lumps after Lipolysis are possible if you inject too deep.
Documentation
Lipolysis-Report 2010
Experienced users reduce the rate of less satisfied
patients
from 16% at the beginning to less than 3%, even 0%.
84% 16% 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
satisfied less satisfied
How satisfied are your patients after the treatment?
Documentation
Measurements Circumference measuring by tape
Use always identical reference points (navel or floor – example „3 cm below navel“)
Use NETWORK measuring tape to measure always with same pressure
Measure after patient has exhaled 6cm over navel
7cm below navel
6cm over navel
7cm below navel
Documentation
Measurements
Caliper - Skin fold measuring
Measure always identical skin folds
Documentation
Measurements
Ultrasound – Fat measurement
Each imaging ultrasound device can be used for fat
measurements.
Such measurements are very accurate when done properly
Information about making aesthetic photos
Photographic picture series in the aesthetic medicine are
showing a change in a temporal interval.
The change of the body contour
The change of the skin structure
Photography
Documentation
lower belly
Before After 2 treatments
2 treatments, no weight loss reduction of lower belly of 9 cm,
Photos: Dr. Hasengschwandtner (A) Pat. 5686
Treatment
Possibilities
Cheeks, jowls, chin, neck
Before After 1 treatment
One treatment session NO WEIGHT LOSS
Photos: Dr. Palmer (GB) NETWORK Representative in UK
Treatment
Possibilities
Example of skin retraction
Before After 1 treatment
after one session of lipolysis, injection of network-compound in jowels,
chin, neck Photos: Dr. Hasengschwandtner (A)
Treatment
Possibilities
lower belly, 46 y.
Before After 2 treatments
2 treatments, from 101 to 93 cm (measured 5 cm below navel)
Photos: Dr. Hasengschwandtner (A) Pat. 5975
Treatment
Possibilities
Saddel bags 29 y.
Before 6 weeks after 1 treatment
One Treatment, -4 cm each side Photos: Dr. Hasengschwandtner (A)
Treatment
Possibilities
Treatment
Intervals
NETWORK recommendation
Time distance between the treatments should be at least 8 weeks ( this is scientifically proven).
Multiple regions minimal 8 weeks
Treat multiple regions at the same time only within the 100ml dosage.
Ultrasonography
Dr. W. Norek /A
first picture: immediately after injection second picture: 4 weeks later
Treatment
Intervals
Ultrasonography
Dr. W. Norek / A
Six and eight weeks after first injection process is active over a period of 8-10 weeks!
Treatment
Intervals
Treatment
Intervals
NETWORK experience If the patient has a normal metabolism :
The melting process starts from the first day on, first visible results are to be seen from the 10th day on. The main melting process takes place between between week 4 and 6
After 8 weeks the process is usually completed.
If the patient has a slower metabolism: The action is slowed! In some cases patients mentioned visible results only after 6 months.
Drinking alkohol during the therapy can slow down or inhibit the hepatic metabolism. (Bad results! are possible)
Treatment
Injection depth
NETWORK protocol
Body: 10 - 12 mm
Face: 4 - 6 mm
Melt the fat always from above downwards.
22,3mm 21,8mm
Injection
depth10-12
mm
Treatment
A case study
Our estimation
Normally you can expect a reduction of
ca. 3-4 cm after 1 treatment
at a normal fatty belly!
Treatment course
1. Patient information
2. Photodocumentation
3. Measuring and weight
4. Mark treatment region
5. Preparing the Compound
6. Treatment
7. After care (PSM)
8. Date agreed upon for control
Treatment expiry
Overview
Regions &
Dosages
Regions
Face
Face Regions
Successful
Injection-Lipolysis
double chin Photos: Dr. Mark Palmer, GB
NETWORK representative vor UK members
Before therapy After 1 treatment
Double chin
Before After 1 treatment
One treatment Photos: Dr. Kai Rezai (GER)
Successful
Injection-Lipolysis
chin, flabby cheeks, neck, 60yrs
Before After 1 treatment
One treatment Photos: Dr. Hasengschwandtner (A)
Pat. 6464
Successful
Injection-Lipolysis
jowls and double chin, 42yrs
Before After1 treatment
One treatment Photos: Dr. Hasengschwandtner (A)
Pat. 5117
Successful
Injection-Lipolysis
axillary fold & upper arms
Before Final result
Photos: Dr. Sierra, Chile
Successful
Injection-Lipolysis
axillary fold and triceps region, 38 yrs
Before After one treatment
One treatment Photos: Dr. Hasengschwandtner (A)
Pat. 5515
Successful
Injection-Lipolysis
58yrs, Dorsal fat & skin laxity
18. March 15. June
Only one treatment on Feb. 19th Photos: Dr. Hasengschwandtner
Successful
Injection-Lipolysis
3. May 19. February
Back-rolls, 34 yrs
Before After one treatment
One treatment Photos: Dr. Hasengschwandtner (A)
Pat. 5086
Successful
Injection-Lipolysis
Lovehandles, 24yrs
Before After one treatment
One treatment, 20 ml compound on each side, 89 cm to 85 cm
Photos: Dr. Hasengschwandtner (A) Pat. 6218
Successful
Injection-Lipolysis
Lovehandles, 34yrs
Before After 2 treatments
2 treatment sessions Photos: Dr. Sierra, Chile
Successful
Injection-Lipolysis
belly & lovehandles
Before 7 weeks after Treatment
Photos: Dr. Holzmüller (A)
Successful
Injection-Lipolysis
abdomen, 23yrs
Before 9 weeks after 1st treatment
Patient wanted to have a washboard belly, without doing exercises Photos: Dr. Hasengschwandtner (A)
Pat. 5071
Successful
Injection-Lipolysis
15 weeks after 2nd
treatment
abdomen, 51yrs
Before After one treatment
one treatment session, no weight loss Photos: Dr. Hasengschwandtner (A)
Successful
Injection-Lipolysis
abdomen
Before After one treatment
One treatment session, no weight loss Photos: Dr. Hasengschwandtner (A)
Successful
Injection-Lipolysis
28yrs, lower abdomen,
Before After one treatment
One Treatment, from 91 to 84 cm
(3 cm below navel), weight loss -1 kg Photos: Dr. Hasengschwandtner
Pat. 5529
Successful
Injection-Lipolysis
Upper and lower abdomen, 51yrs
Successful
Injection-Lipolysis
one treatment, upper reduced from 83 to 76 cm, lower from 93 to 88 cm, iliac crest 1 shot; -0.5 kg, control picture after one year right
hand side.
Photos: Dr. Hasengschwandtner (A) Pat. 5845
Lower abdomen
Before After one treatment
Photos: Dr Mark Palmer, UK NETWORK representative for UK members
Successful
Injection-Lipolysis
abdomen
Before After one treatment
two treatments, weight loss ½ kg reduction of lower belly from 101 to 92 cm
Photos: Dr. Hasengschwandtner (A) Pat. 5190
Successful
Injection-Lipolysis
inner thighs, gluteal fold, 34yrs
Before After 2 treatments
two sessions, no weight loss Photos: Dr. Hasengschwandtner (A)
Pat. 5546
Successful
Injection-Lipolysis
gluteal-banana, cellulite, 52yrs
Before After one treatment
one treatment, right side Photos: Dr. Hasengschwandtner (A)
Pat.5968
Successful
Injection-Lipolysis
Inner thighs
Before –
Skin contact on inner thighs
After 2nd treatment
Still a small gap on inner thighs
when knees are in contact
2 treatments, Photos: Mark Palmer MD, UK
Successful
Injection-Lipolysis
After 1st treatment
36yrs, Iliac Crest
Before After one treatment
One Treatment, -9 cm Photos: Dr. Hasengschwandtner
Pat. 6106
Successful
Injection-Lipolysis
Saddle bags
Before After 5 treatments
Five treatments, -14 cm each, -5kg Dr. Thierry Marechal (Paris, F) NETWORK representative for French members
Successful
Injection-Lipolysis
Photos: Prof. Nour El-Din, Egypt NETWORK representative for Egypt members
Successful
Cellulite-Treatment
.
Cellulite-Therapy
Cellulite-Therapy Photos: Prof. Nour El-Din, Egypt
NETWORK representative for Egypt members
Successful
Cellulite-Treatment
.
Male breast
Before After 2nd treatment
2 treatments third injection only on right side planned
Photos: Dr. Hasengschwandtner (A) Pat. 5329
Successful
Injection-Lipolysis
unilateral lipomasty, 31yrs
Before After 1st treatment
Young man, examination of all blood values as recommended, eventually mammography, one session,
Photos: Dr. Hasengschwandtner (A) Pat 4803
Successful
Injection-Lipolysis
Lipomastia, 56yrs
Before 9 weeks afster 1st treatment
one treatment, 15 ml each side Photos: Dr. Hasengschwandtner (A)
Pat. 5010
Successful
Injection-Lipolysis
68yrs, Lipoma Two sessions, 10ml pure PCDC each
Photos: Dr. Hasengschwandtner Pat. 4920
Successful
Injection-Lipolysis
before
2 weeks after
1st treatment
11 weeks after
2nd treatment
23 weeks after
1st treatment
Lipoma, 47yrs two treatments, Photos: Dr. Hasengschwandtner (A)
Pat. 5783
Medical indication
Lipoma
Madelung‘s deformity one treatment, buffalo hump,
Photos: Dr. Hasengschwandtner (A) Pat. 6024
Med. Indikation
Lipoma
Supporting
Combi therapies
After the swelling is gone
Lymphatic drainage
Endermology treatment
(after 3. day)
During and after the treatment
During
Radio frequency
Mesotherapy
Ultrasound
After
Thermage
Filler
Botulinumtoxin A
Combi therapies
during & after
40yrs, cheeks, jowls, chin
After 2 Lipolysis sessions on cheek, nasolabial fold, jowls, chin, 1 session with Botox glabella, lateral eyelid, Restylane on lips, 1 session Mesolift in face and neck
with hyaluronic acid. Photos: Dr.
Hasengschwandtner (A)
Combi therapies
Injection-Lipolysis
44yrs, 1 lipolysis on jowls and nasolabial fold, filler in cheeks and malar
region
Before After finishing the combination-
treatment
(In jowls 3 shots each side with 0.5ml compound, in nasolabial fold only 2 shots of 0.2ml each side, 1ml Hyacorp on each side in malar region and 1ml each side in cheeks, Azzalure in front.)
Photos: Dr. Hasengschwandtner (A)
Successful
Injection-Lipolysis
The NETWORK PSM Pain & Side effect Management During the treatment
• Local anaesthesis for special cases Direct after the Treatment
• Ultrasound after treatment
• AfterCare Gel Up to 7 or 14 days after the treatment
• AfterCare Gel Up to 10 days after the treatment
• Degozym (Bromelain & Papain combination)
After care
PSM-Management
Pain & side effect management
Local anaesthetics
• In certain cases, f.i. if you treat painful areas likes jowls, triceps region or very small fat pads, you can add 1ml of Xylocain or Lidocain (2% - without vasoconstrictor) to the compound.
• 1ml anaesthetic mixed in the syringe with 10ml PC/compound solution brings sufficient pain reducing effect. Toothache feeling does not come up after injecting jowls.
After care
PSM-Management
References for patients
Patient should wear extent clothes for body treatments
After treatment: 30 min. relaxing in the practice
During 1st day Drink a lot of water!
Avoid sun or solarium during first week to avoid hyperpigmentation
Use sunblocker durig 1st month if you have sun exposition
For sports: compressing garments can be helpful!
After care
Patient-Information
Studies – pro and contra
Pro
Uni Regensburg 1 (09) Prof. Göpferich, Dr. Blunk, Silvan Klein, Prof. Dr. Prantl
Uni Regensburg 2 (09) Prof. Dr. Prantl
Uni Bochum (06-09)
5 Publicationen Dr. Hoffmann, Dr. Bechara
US Study of ASAPS(10) Leroy Young, MD, American Society of Aesthetic & Plastic Surgery, FDA agreed, with NETWORK Compound
Neutral
Dr. Schuller-Petrovich (A)
Contra
Pig Poster Brasil (05) Only 1x shown on a congress (Brasilia)
Dr. Kopera (A) (08)
Actual discussion
Studies
Injection-Lipolysis in 2009
ISAPS survey in 2009 with plastic surgeons (30,817) in 25 Top-countries:
•17,1 Mio aesthetic treatment
•8,5 Mio invasive treatment
•8,6 Mio non-invasive treatment
•2,8 Mio Botulinum treatment
•1,6 Mio Liposuction
•65.486 Lipolysis treatment
Actual discussion
NETWORK
USA reports 12,448 Lipolysis treatments by plastic surgoens. Place 1.
German plastic surgeons reports 6,516 Lipolysis treatments gemeldeten
NETWORK member reports additional more than 100,000 Lipolysis treatments by dermatologist and general practioners in 2009.
„NETWORK LIPOLYSIS“ -
the world‘s largest Lipolysis Community
Discuss your ideas and results with experts and members inside of NETWORK Lipolysis.
Together we will develope the lipolysis therapy continuously:
• on member congresses (MASTER-Conference)
• on Aesthetic-Holidays
• inside the member chat room
• by hotline to Dr. Franz Hasengschwandtner Medical and Scientific Director of NETWORK-Lipolysis
Actual discussion
NETWORK
Workshop
Many thanks
The Vision
Many thanks
for your attention!
Thank You