is not aimed at frightening or turning doctors and patients away from
contrary, a person that is well informed, is well equipped.
For doctors -
it is another reason to think about the level of their professional grounding
in the sphere of mesotherapy.
- it is another reason to think about confidence to a doctor.
both doctors and patientsfall for the bait of advertising, not taking into
account possible consequences.
As a result, distributors
(not always honest) are the winners, and trustful doctors and their patients
loose in this situation.
That’s why we
wish doctors and their patients to be wise and reasonable in choice of each
other, as well as of methods and drugs for mesotherapy.
order to attract patients, managers of beauty shops announce mesotherapy to be
a very efficient method of treatment (rejuvenation) that is absolutely painless
and doesn’t have any side effects or complications.
We pity if
anybody believes in it. Any efficient method of treatment or drug has side
effects and complications. Moreover, the more active a drug/method of treatment,
the more expressed the side effect can be.
is to choose the most efficient method and drug with minimum harm to the patient’s
health. And the result must be active for a long time.
complications occur rarer when the qualification and intellectual level of a
mesotherapist are higher.
As a rule, complications
appear when a doctor has low professional training; disregard antiseptic and
aseptic rules, uses illegal or non-examined drugs.
necessary to not confuse such concepts as complications and undesirable effects!
following effects are ascribed to the complications:
reactions (erythema and leukoderma);
of epidermis, etc.
mesotherapy practice – these are undesirable side effects, pay for the
advantages that mesotherapy gives in treatment and prevention of diseases, in
correction of aesthetical defects.
pain (short-term and moderate painful influence) has physiological importance,
because it stimulates emissions of catecholamines and somatotropin, working out
of collagen, lipolysis, improvement of perfusion and many others).
influencing on the painfulness of the procedures:
1. Individual characteristics of a
- threshold of pain;
(season, day, menstruation, etc.);
situation (because often people need medical help exactly during stress);
condition and mood for the result.
A course of
mesotherapy must be planned taking into account these factors.
2. Mistakes in technique, or necessity to use
problem can be solved by acquiring practical skills, using of needles and
regimes of mesoinjector with little traumatic effect.
case anesthesia and analgesic methods are more actual.
3. Local stimulation of nociceptors with drugs.
In order to
avoid all these effects, it’s necessary to have good knowledge of pharmacology,
to use correct local anesthetics in the composition of mesotherapeutic
mixtures, or to practice preliminary anesthesia (analgesia) to make the
procedure less painful.
Local bleeding and hemorrhage
are unavoidable reality of injection way of drugs’ introduction (withpenetration through basal
membrane of skin, where vessels are located).
Intensity of bleeding and hemorrhages
- diameter of a needle or properties of a vessel (the more diameter
a needle has or the more lumen a vessel
has, or the more blood pressure is inside it, the bigger area a hematoma
- condition ofcoagulant and anti-coagulantsystem of blood of a patient;
of vascular walls (vessels’permeability, capillary fragility, for women the period of
menstruation has high importance).
Mesotherapy can cause single and multiple hemorrhages or hematomas, which appear to be:
defects, if they are located on the open areas of skin;
- strongstimuli forcoagulant and anti-coagulantsystems of blood, immunity, local enzymic processes, reparation
processes, synthesis of skin proteins, etc.
The following measure can help to minimize hemorrhages:
- correct performance of techniques and methods of
- usage of
atraumatic thin needles, 0,26-0,3
mm in diameter;
- pressing of
perforated vessels till full stop of bleeding;
- correct selection of drugs;
of the condition of coagulant system (repeal ofanti-coagulant and anti-aggregant drugs a day before and 2-3 hours after
the mesotherapy session);
of vascular wall andreduction of its permeability (angioprotectors in
mesotherapeutic and system way);
of general and local blood pressure (arterial andvenous);
of penetration of a needle in superficial vessels, etc.
Change in microcirculation – erythema,
mechanical impact to skin usually causes change ofcutaneous covering («white» or «red»
dermographism), depending on the predominance of influence of sympathetic or
parasympathetic nervous system of a patient.
stimulating of skin receptors is much stronger stimulus that’s why almost all
patients can have vascular reactions.
mesotherapy provokes the inversion of vascular tonus (skin paling is against
the background of erythema and skin redness is against the background of
paleness). This indicates regulating
mechanic influence of meso needle on the receptors of nervous and vascular
systems, located in skin, and influence
on nervous system is primary.
vasoactive drugs allows to reach the required result – vasodilatation or
erythema appearing during mesotherapy session usually passes after 20-40
minutes except the cases (under indications or by ignorance) of usage ofvasoactive or stimulating drugs.
are used in mesotherapy only under the strict indications because persistent
vasoconstriction can lead to local dystrophy and even skin necrosis.
changes of microcirculation must be treated because they can lead to pathology
of skin and subcutaneous fat.
Mesotherapy complications can be as follows:
- iatrogenic(provoked by the actions of
medical personnel, for example, a doctor without necessary qualification, not
following the rules of antiseptics, not possessing enough knowledge and
practical skills in mesotherapy and mesopharmacology, not knowing the
peculiarities of mesotherapeutic usage of drugs, at the worst, provoked by the
actions of paramedical personnel or cosmetologists not having medical education
-technogenic (provoked by incorrect use of equipment and techniques
- pharmacogenic (provoked by activity of
can be predictable and unpredictable:
- unpredictable complications are those
that can be hardly predicted and that’s why are hardy prevented and treated,
appear at the use of mesodrugs of doubtful origin, with unknown composition,
not registered as drugs, not accepted officially, not having detailed
description and instruction;
- unpredictable complications are the side
effects of drugs in cases of idiosyncrasy, overdosage or unreasonable use, but under
the condition of knowledge their full composition (not only active components)
because additional components can provoke undesirable reactions from local
irritation toanaphylactic shock.
most dangerous complications from all possible are allergic reactions of
immediate type, which threaten the patient’s life.
There areinfectious or infectious-toxic,
as well as histotoxic (necrotic) complications that placed on the second position.
First local inflammatory reaction (infiltrate,lymphangitis,
lymphadenitis, abscesses, and gangrene) can appear, and without adequate help general
shock) can appear after it.
connected with side effects of drugs are less dangerous for patients. At a good
knowledge of clinical pharmacology in general and mesopharmacology in
particular, they can be predicted, prevented and in case of their appearance –
Examples of predictable complications:
- monopreparations or ready cocktails containing thyroid hormones
(triiodothyronine,triac) are often used at treatment of cellulopathy
(cellulite, hudrplipodystrophy, obesity), without preliminary endocrinological
examination and indications.
- manifestation or progression of pathology of a thyroid gland (hyperthyroidism
- depression of the production of native hormones;
- producing of antibodies which block introduced and native hormones;
- reciprocal inhibition of secretion of thyrotrophic hormone and intensifying
of secretion of thyreostatin (triac is used right to suppressthyrotrophic hormone);
- withdrawal syndrome.
does such therapy can have? (Let’s remember bio additive Li Da)
therapists introduce collagen, elastin aimed at improving skin turgor. Whatitcanbefraughtwith?
reactions are mostly provoked by the proteins, to which class thesesubstances
- protein redundancy (for example, collagen) provokes increase of
producing of proteolytic enzyme, in this case –collagenase, which destroys both
exogenous and endogenous collagen (this causes primary apparent cosmetic
effect, which is changed later for the following dermodystrophia leading to
dependence from the introduction of proteine from outside);
introduction of collagen doesn’t create conditions for its «correct» spreading
in connective tissue, because it has high molecular weight that limits its
example concerns use of a drug phosphatidylcholine which is ascribed to have steatolytic activity. In truth it provokes
necrosis of tissues.
Local use of phosphatidylcholine is prohibited al over the world,
even in the USA,
where it is widely promoted. It is used only for the decrease of local
lipopexia (steatoma, lipoma).
Using of this drug
for big areas causes necrosis of tissues similar to necrosis at
introduction of calcium chloride to tissues. What happens in the focus of
necrosis? Destruction of tissues, i.e. alteration is the first stage of
inflammation which is followed by the stages of exudation and proliferation.
The result of such process is creation of connective tissue – fibrosis and
means for a patient? First he will have pain and edema, then they will be less
or even disappear at all, but the process in subcutaneous fat will be
As a result,
cellulite will progress later, but in the fibrosing stage, and later it will be necessary to treat edema,
complications of cellulite treatment with phosphatidylcholine (photo materials
from the open foreign resources).
most dangerous for life and health of patients are immediate allergic
reactions, including anaphylactic shock, Quincke's edema andasthmatic status.
symptom or even the precursor of development of anaphylactic shock
is sharply apparent local reaction in the place of allergen’s introduction in
organism – unusually sharp pain, strong edema, swelling and reddening in the
place of a drug injection, strong itch spreading fast all over the skin
(pruritus generalisatus). At the introduction of allergen orally the first
symptoms can be sharp pain in stomach, nausea, vomiting, edema of larynx and
In short time
these symptoms are followed with apparent edema, bronchiospasm laryngospasm,
leading to harsh heavy breathing. It will lead to tachypnoe, asthmatic
breathing. Hypoxia starts. A patient pales, lips and visible mucous tunics, as
well as outlimb (fingers) can become cyanotic (blueish). Blood pressure of a
patient will goes down quickly and a collapse progresses. Apatientcanfaint.
shock progresses very fast and can lead to the death in some minutes or hours
after the introduction of allergen into the organism.
At less heavy processing of the shock symptomatology can include the following
- felling of fever
with sharp hyperemia of skin,
excitement or contrary, depression, flabbiness
- anxiety, fearofdeath,
- noise or
pain behindbreast bone,
- skin itch,
urticaria, confluent rash,
- angioneuroticedema (Quincke's type),
in nose, rhinorrhea
- itch and tickling
- spastic drycough, etc.
After prodromic effects there is a fast (from some minutes to an hour)
processing of symptoms and syndromes that condition the following clinical
Pruritus generalisatus and urticaria take place not in all cases. At the heavy
cases skin manifestations (urticaria, Quincke's edema) are absent. They can
appear 30-40 min later from the beginning of reaction and finish it. It appears
that in such case arterial hypotension brakes progressing of urticaria and reactions in the place of sting.
They appear later when blood pressure becomes normal (at going out of
symptoms are usual for it: spasm of unstriated musculature of viscera with the clinical
manifestations of bronchiospasm (cough, expiratory dyspnea), spasm of
musculature of gastrointestinal tract (crampy abdominal pains,nausea,
vomiting, and diarrhea), women can also have spasm of uterus (pains in down
part of stomach withblood-tinged discharge
effects are aggravated by edema of mucous tunic of viscera (respiratory and
Presentation of asphyxia can progress at the apparent
edematic syndrome and the localization of pathological process at mucous tunic
of larynx. Phenomena of dysphagia can take place at edema of larynx.
allergic reactions heart appears to be the organ-target (direct influence of
mediators to myocardium). Patients have compressing pains in heart, tachycardia.
Electrocardiogram made during anaphylactic shock and one week after it
registers derangements of heart rate, diffusive disorder of trophism of myocardium
with it’s further normalization in dynamics.
hypocapnia appear at non-heavy anaphylactic reactions.
At the heavy anaphylactic shock hypoxemia as well ashypercapnia and andacidosis become more
disorders at anaphylactic reaction can have different levels ofseverity – from the moderate lowering of
arterial blood pressure with subjective feeling of near-unconscious condition
to the heavy hypotension with loss of consciousness (for an hour and more).
have the typical appearance: sharp paleness (sometimes, cyanosis) of skin,
sharpened face, cold clammy sweat, sometimes foam from the mouth.
examination: arterial blood pressure is low or not defined, rapid pulse,
cardiac tones are indistinct, in some cases are not heard, accent of the second
heart sound can appear above the pulmonary artery.Rough breath sounds,dry rales are in
clonic convulsions can appear as a result of ischemia of central nervous system
and edema of serous tunic of brain. Unintentional defecation and urination are
not rare on this stage.
There is a
high possibility of fatal outcome without timely intensive care. Howeverandtimelyrapidcarecan’talwayspreventit.
of anaphylactic shock
measure at anaphylactic shock must
be urgent injection of adrenaline- 0.2-0.5 ml of 0.1 %
solution hypodermically or better intravenously. Injection of adrenaline can be
repeated up to total general dose 1-2ml
of 0.1 % solution for the short time period (several minutes), but in any
case itmust be injected with the divided
follows adrenaline is introduced as needed, taking into account the short
period of its semiejection, depending on arterial blood pressure, cardiac
rhythm, overdose symptoms (tremor, tachycardia, muscular twitching). It is not
allowed to overdose adrenaline, because its metabolites have the ability to
worsen course of anaphylactic shock and
to block adrenoreceptors.
must be injected after adrenaline. The doses of glucocorticoid necessary to
stop the anaphylactic shock are tens times more than «physiological» doses and
many times more than doses used for the treatment of chronic inflammatory
of glucocorticoids at anaphylactic shock is a 1 «large» ampoule of
methylprednisolone (as for pulse-therapy) with the volume of 500 mg (i.e. 500 mg
of methylprednisolone), or 5 ampoules of dexamethasone, 4 mg each (20 mg), or 5
ampoules ofprednisolone, 30 mg each (150 mg).
have little effect. The necessary dose is defined by the condition of a
glucocorticoids as opposed to adrenaline, appears not immediately but tens of
minutes or some hours later, but it lasts longer.
indicated to inject antihistaminic drugs which don’t lower arterial blood
pressure and don’t have high own allergic potential: 1-2 ml of 1 % dimedrol
or suprastin, tavegil.
contraindicated, because it has as well as all derivatives of phenothiazine the
considerable own allergic potential, and besides that it lowers arterial blood
pressure that is low enough as it is.
Injection of chloride
or gluconate calcium is not only contraindicated but can also affect negatively
on the patient’s condition.
There is an
indication of the slow intravenous injection of 10-20 ml of 2.4 % solution
of aminophylline aimed at taking the bronchiospasm away, decreasing the pulmonary
edema and relieving the breath.
In case of
need it is necessary to make artificial lung ventilation and external cardiac
with anaphylactic shock must be laid in
horizontal position with the lowered or flat (not picked up!) head for better
blood supply of brain (taking into account low arterial blood pressure and low
perfusion of brain). Apply inhalation of oxygen,intravenous
drop-by-drop introduction of physiologic saline or another water-salt solution
for the restoration of hemodynamic indices and arterial blood pressure.
Cordiamin,caffeine,corgliconum, strophanthine in ampoules,penicillinasein ampoules,tongue forceps,
mouth-gag,100 ml ofethanol,
cotton,gauze tampon, scalpel,oxygenous pillow, tracheostomy orintubation set,etc.
necessary to collect the allergological anamnesis very carefully and to make
must stay in clinic minimum 40-60 minutes after the introduction of drugs.
At the suspicion
of any allergic reaction, it is necessary to stop the session, to provide
dynamical medical supervision. At the confirmation of the suspicions of
allergic reaction it is necessary to begin rendering medical aid and at the
same time to call an emergency team.
necessary to prepare information about the introduced drugs (commercial name of
drug/drugs, composition, active and additional components, injected doses,
methods of introduction, results of allergic test, etc.).
mesotherapy heavy allergic reactions are very rare, every doctor must be ready
to render emergency medical aid and a patient must be informed about the consequences
of mesotherapy (not only about complications but also about possible hematomas
and painfulness of the procedure, about behavior during the period of
rehabilitation and so on).