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



- a hypothesis

In vivo lysis of adipocytes

Photos: Dr. Hasengschwandtner

10 days after lipolysis

Adipocytes

Membran destruction

Emulsification

Transportation into the liver

Metabolism


- a hypothesis

PC injection

The most important

steps in dissolving the

subcutaneous fat!


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


after one session of lipolysis, injection of network-compound in jowels,

chin, neck Photos: Dr. Hasengschwandtner (A)

Treatment

Possibilities

lower belly, 46 y.


2 treatments, from 101 to 93 cm (measured 5 cm below navel)


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


One treatment Photos: Dr. Kai Rezai (GER)

Successful

Injection-Lipolysis

chin, flabby cheeks, neck, 60yrs


One treatment Photos: Dr. Hasengschwandtner (A)

Pat. 6464

Successful

Injection-Lipolysis

jowls and double chin, 42yrs

Before After1 treatment


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


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



Pat. 5086

Successful

Injection-Lipolysis

Lovehandles, 24yrs


One treatment, 20 ml compound on each side, 89 cm to 85 cm


Successful

Injection-Lipolysis

Lovehandles, 34yrs


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


one treatment session, no weight loss Photos: Dr. Hasengschwandtner (A)

Successful

Injection-Lipolysis

abdomen


One treatment session, no weight loss Photos: Dr. Hasengschwandtner (A)

Successful

Injection-Lipolysis

28yrs, lower abdomen,


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.


Lower abdomen


Photos: Dr Mark Palmer, UK NETWORK representative for UK members

Successful

Injection-Lipolysis

abdomen


two treatments, weight loss ½ kg reduction of lower belly from 101 to 92 cm


Successful

Injection-Lipolysis

inner thighs, gluteal fold, 34yrs


two sessions, no weight loss Photos: Dr. Hasengschwandtner (A)

Pat. 5546

Successful

Injection-Lipolysis

gluteal-banana, cellulite, 52yrs


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


One Treatment, -9 cm Photos: Dr. Hasengschwandtner

Pat. 6106

Successful

Injection-Lipolysis

Saddle bags


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


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,


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

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