MESOTHERAPY
Dr. Tarek El Tanbouli

Injection of small doses of medications in the
mesoderm with very good effect on treating
dermatological lesions (ectoderm) or even
internal lesions as GIT (endermic).
 This term is suggested by Dr.Michel Pistor
(French doctor 1958).
 Meso.= Middle; since we are aiming at correct
location.
OR = mean : Intermediary dosage between
Allopathic therapy and Homeopathic therapy.
Dr. Tarek El Tanbouli
History
 After many previous studies in Europe
started 1793 (Belgium + France) for
injecting local anesthetics and
histamine to treat musculoskeletal,
tendon and Trigeminal pain lesions.
 In 1948 Dr. Michel Pistor started pain
treatment mainly with local infiltration
of Procaine.
Dr. Tarek El Tanbouli
History (cont.)
 In 1958, the name Mesotherapy is suggested for
the 1st time after discovering more injection sites
to treat more medical problems.
 In 1964 Dr.Pistor founded the French
Mesotherapy Society.
 In 1976 1st International Mesotherapy Congress.
and the 1st Hospital outpatient service for
Mesotherapy is created.
 2002 creation of University Diploma in
Marseille, Bordeaux and Paris.
Dr. Tarek El Tanbouli
Indications
A) Aesthetic:
1) Lipolysis.
2) Cellulite.
3) Hair loss.
4) Scar.
5) Anti ageing.
6) Meso-Buttox.
Dr. Tarek El Tanbouli
Indications (cont.)
B) Pain:
1) Sport’s injuries.
2) Chronic inflammatory disorders
(Rheumatic, Sacroiliatis, Knee & Shoulder
osteoarthritis, etc…)
C) Others:
G.I.T. disorders,insomnia, tonsilitis … etc
Dr. Tarek El Tanbouli
Contraindications
1)
2)
3)
4)
5)
Pregnant Female.
Nursing Female.
D.M. ( O.k. if controlled –be sure )
Heart Dis. (arrhythmias )
Children.
Dr. Tarek El Tanbouli
Instructions After Treatment
for 24 hrs.
1.
2.
3.
4.
No Exercise.
No Massage.
No Hot Shower.
No Caffeine.
Dr. Tarek El Tanbouli
Drugs Used
Dr. Tarek El Tanbouli
A) Lipolytic drugs:
1.
2.
3.
4.
5.
6.
PPC
Caffeine
Aminophylline
Yohimbine
L – Carnitine
Co enzyme A
Dr. Tarek El Tanbouli
B) Trophic drugs:
1. Silicum = Conjunctyl
2. Vit. C
3. Multivitamins
4. Artichoke
5. Na pyruvate
6. Hyaluronic acid
Dr. Tarek El Tanbouli
C) Vasodilator drugs:
1. Calcitonin
2. Fonzylane
3. Torental
4. Dicynone
D) Local anaesthia
Lidocaine
Dr. Tarek El Tanbouli
Phosphatydilcholine
 The best lipolytic drug is PPC without any effect
on weight loss.
 Either injected pure (Brazil) or diluted with saline
Or in combination e.g.; Lidocaine 2.5 ml
Saline 2.5 ml
PPC
5 ml
Aminophylline 5ml
 In France PPC is not allowed; so using local
anesthetic + Lipolytic drug + Trophic drug +
vasodilator drug.
Dr. Tarek El Tanbouli
Phosphatydilcholine (con.)

PTC is lecithin from soya beans ( have 2 unsaturated fatty acids
= linoleic + alpha linoleic acid)
 PTC is produced in the body but have saturated fatty acid (
Palmitic + oleic + streaic acid ) in cell membrane of:
 Liver cells.
 Adipocytes.
 Lungs of embryo from 4th month. “with more palmitic acid”
preventing its sticking so allowing inflation + deflation of
lungs (stimulate lung surfactant)
Dr. Tarek El Tanbouli
Phosphatydilcholine (con.)
 PTC. To be injectable needs:
1) A solvent which is deoxycholic a. ( gallic a.)
2) A preservative which is Benzyl alcohol ( now
known as PPC).
 PPC max. dose in lipolysis = 2500 mg / session
(every 4 – 8 w )
 Each area needs 1 – 4 sessions to get the results.
(72 % of pt. need 2 session only).
Dr. Tarek El Tanbouli
PPC helps dissolving the double layer of
adipocytes producing nano size fat particles.
At the same time, helps enzymes of mitochondria
of adipocytes to break down the triglycerides into
mono ( continue for 8 w ).
99% of dissolved fat transported to liver where
metabolized into CO2 + H2O.
1% are transported to kidney.
Dr. Tarek El Tanbouli
Types of injections
1. IED = Intra Epidermic (1 mm depth)
2. IDS = Intra dermal superficial (1-2 mm depth)
N = Nappage = multi-pricking technique for cellulite
+ mesolift
PPP = point by point or papule technique for
tonsillitis + insomnia
3. IDP = Intradermal (4 mm depth)
for hair loss 3 mm by oblique injection.
4. Mesoperfusion ( 5-6 mm depth)
5. IHD = Intra hypodermic (6-13 mm depth)
for lipolysis + iliolumbar lig. pain
Dr. Tarek El Tanbouli
Dr. Tarek El Tanbouli
Dr. Tarek El Tanbouli
Dr. Tarek El Tanbouli
Dr. Tarek El Tanbouli
Cellulite
 It is lumpy, orange peel, or cottage cheese
appearance of skin by strangled fat cells.
Fat cells are held in place by a mesh of collagen
fibers in the subcutaneous tissue.
If fat cells bloated with water or fat, cellulite appears
i.e. “fat cells bulge out the mesh of collagen fibers”.
Dr. Tarek El Tanbouli
Dr. Tarek El Tanbouli
Dr. Tarek El Tanbouli
Dr. Tarek El Tanbouli
Factors Causing Cellulite
1.
2.
3.
4.
Hereditary
Pregnancy
Drainage problem (sp. lymphatic ).
Obesity
Dr. Tarek El Tanbouli
Interstitial or extracellar matrix is
composed of:
1. Fibroblasts (structural fibrous protein )
2. Glycosaminoglycans
3. Glycoprotein (adhesive ptn.)
4. Proteoglycans
Dr. Tarek El Tanbouli
Cellulite appears if interstitial matrix is affected
by:
1. Decreased collagen function + production
2. Decreased Elastin
3. Decreased Flow of micro circulation ( due to
acidosis + increased free radicals
4. Increased capillary permeability leading to
increased free water and then lipedema
Dr. Tarek El Tanbouli
Cellulite classifications
1. 1st degree = cellulite does not appear if skin is
punched.
2. 2nd degree = cellulite only appear if skin is
punched but not appear during standing or
laying down.
3. 3rd degree = cellulite appear during standing
and punching the skin but not on laying down.
4. 4th degree = in all condition.
Dr. Tarek El Tanbouli
Dr. Tarek El Tanbouli
Treatment of cellulite
1. Decrease lipoedema by Procaine +
Benzopirone.
2. Stimulate micro-circulation by Procaine + vit
C + penthoxiphylin.
3. Stimulate lipolysis by procaine + PPC ±
theophylline ± caffeine ±carnitine ±yohimbin.
4. Stimulate C.T. regeneration by Conjunctyl.
Dr. Tarek El Tanbouli
Dr. Tarek El Tanbouli
Dr. Tarek El Tanbouli
Dr. Tarek El Tanbouli
Dr. Tarek El Tanbouli
Treatment of Flacidity of Arms
and Inner thigh
1. DMAE : Di methyl amino ethanal
using 2 – 4 ml (25 mg / ml).
2. Vit.C using 2 ml (222 mg / ml)
3. Procaine using 1 ml (2%)


For one thigh or arm.
Need 20 treatments with 2 weeks apart by
PPP or Nappage injections.
Dr. Tarek El Tanbouli
Complications
You have to alert your patients to all side effects:
1 ) Vasovagal Syndrome:
Vasovagal Syndrome due to many injections (100200)
a- Before treatment ask pt.
 If dizziness or nausea occur to stop injections
and give O2 mask for 2-5 min at 4 - 8 L /min.
 Ask pt. to stay after injection in the clinic to
be sure no loss of consciousness.
Dr. Tarek El Tanbouli
Complications (cont.)
b - Before treatment eat sugary or
ptn. diet (more empty stomach
more attacks).
c - Injection better while lying down more
than standing position which may be
lethal with loss of consciousness.
Dr. Tarek El Tanbouli
Complications (cont.)
2.
Pain:
 Dull or burning pain at area of injection which become
warm + red, within 5 min, lasts from 10 min. To few
days.
 Not treated by NSAID’s but better with mild narcotics as
Hydrocodone or weak opiods e.g. tramal or distalgesic.
3. Nodules: occurred with non expert doctors or increased
conc. of PPC.
4. swelling: may start immediately + persist 1 week or more.
Dr. Tarek El Tanbouli
Complications (cont.)
5. Bruising: persist 1 – 2 weeks so pt. must plan
their treatment according to their schedule sp.
wedding, swimsuit & modeling photo shoots.
6. Nausea – or + diarrhea: due to cholinergic
reaction (sp. aminophylline 250 mg)
Treatment: Antiemetic or H2 blocker
(Zantac).
Dr. Tarek El Tanbouli
Complications (cont.)
7.
Palpitations:
 Increased in Hypertensive pt.
Give O2 mask + diazepam ( tranquilizer ).
 Occurs with:
a) aminophylline if its serum level >20 mg / ml.
b) Yohimbine (parasympathomimmetics).
8. Allergy:
 Sp. with a) Hyaluronidase b) PPC.
 Treat as any allergic reactions;
Dr. Tarek El Tanbouli
Dr. Tarek El Tanbouli