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Background Androgenetic alopecia (AGA) is the most common form of alopecia in men, affecting 70% by the age of 20 years. The present study was conducted with the objective of comparing the efficacy of monotherapy with topical 5% minoxidil and its combination with intradermal platelet rich plasma (PRP), in male AGA. Methods This observational study was conducted at the dermatology department of a tertiary care hospital over a duration of 2 years. 100 patients with AGA were selected and divided randomly into 2 treatment arms: Group A (MM): received topical 5% Minoxidil monotherapy for 12 months and; Group B (M + PRP): received combination therapy of PRP and topical 5% Minoxidil for 12 months. The following parameters were subsequently analyzed on follow up: Physician-assessed global photography by a 4-point improvement scale and trichoscopic improvement of mean hair diameter. Results The combination was statistically superior to the monotherapy group in promoting hair growth in men with AGA for both measures of hair growth – photographic assessment and trichoscopic mean diameter. Conclusion We hereby conclude that intradermal PRP injections should be offered to all patients with AGA along with the existing therapeutic modalities, for faster hair regrowth and improved compliance.

Introduction Musculoskeletal pain such as low back pain (LBP) are routinely encountered in the ED and contribute to ED overcrowding. The aim of our study was to compare the efficiency of mesotherapy with systemic therapy in pain control in patients with lumbar disk herniation. Methods We conducted this prospective parallel randomized controlled trial with the patients admitted to the emergency department with low back pain related to herniated lumbar disk. Mesotherapy was performed to one group, while intravenous dexketoprofen was administered to the control group. Changes in pain intensity at 15th minute, 30th minute, 60th minute and 24th hours after treatment using Visual Analogue Scale (VAS), need to use analgesic drug within 24 h after treatment, and adverse effect of the treatment methods were compared between groups. Results The decreases in pain intensity were statistically significantly higher in mesotherapy group for all time intervals. The need to use analgesics was statistically significantly three fold higher in the systemic therapy group. There was no statistically significant difference in having any adverse effect between study groups during one-week follow-up period. Conclusions Changes in medical practices, from the systemic administration of NSAIDs to the minimally invasive techniques such as mesotherapy with potent efficacy and minimal side effects, may enhance the ability of EDs to meet the waiting time targets and improve patient's satisfaction.

The incidence of nontuberculous mycobacterial infections is increasing worldwide; by 2017, more than 190 species and subspecies have been documented. Although classically associated with immunosuppression, the recognition of these etiological agents in diseases affecting immunocompetent individuals and in healthcare-associated infections, such as after surgical and cosmetic procedures, makes the study of the epidemiology and pathogenesis of these microorganisms relevant in medical practice. Mycobacterium lentiflavum is slow-growing and rarely affects the skin. A case of cutaneous mycobacteriosis caused by M. lentiflavum is reported in an immunocompetent patient after subcutaneous injection of a lipolytic compound, treated with clarithromycin and levofloxacin.

Background Topical minoxidil and oral finasteride are the only drugs approved for the treatment of androgenetic alopecia (AGA) in Spain. However, the management of this condition is highly variable because numerous treatments are used off-label. The main aim of this study was to describe the prescribing habits of dermatologists in Spain for male AGA (MAGA) and female AGA (FAGA). Material and methods Descriptive cross-sectional study using online questionnaires completed by dermatologists working in Spain. Results The responses of 241 dermatologists were analyzed. The most common treatments prescribed for MAGA were minoxidil (98%), oral finasteride (96%), nutricosmetics (44%), topical finasteride (37%), oral dutasteride (33%), platelet-rich plasma (14%), and low-level laser therapy (8%). For premenopausal FAGA, the most common treatments were topical minoxidil (98%), oral contraceptives (81%), nutricosmetics (72%), cyproterone acetate (58%), oral finasteride (39%), topical finasteride (39%), spironolactone (27%), platelet-rich plasma (20%), oral dutasteride (20%), oral flutamide (18%), and low-level laser therapy (7%). Finally, for postmenopausal FAGA, the most common treatments prescribed were topical minoxidil (98%), oral finasteride (84%), nutricosmetics (68%), topical finasteride (50%), oral dutasteride (35%), platelet-rich plasma (21%), spironolactone (16%), cyproterone acetate (16%), oral flutamide (9%), and low-level laser therapy (9%). A limitation of our study is that we did not analyze novel AGA treatments such as oral minoxidil and dutasteride mesotherapy. Conclusions The most common treatments prescribed for AGA by dermatologists in Spain are topical minoxidil, oral finasteride, and nutricosmetics for MAGA and postmenopausal FAGA and topical minoxidil, oral contraceptives, and nutricosmetics for premenopausal FAGA.

A 28-year-old white female patient presented with multiple erythematous-to-violaceous, painful, suppurative nodules on the buttocks and thighs that appeared after two weeks of mesotherapy with deoxycholate, caffeine, sunflower liposomes, and sinetrol for localized fat. She was treated for atypical mycobacteriosis, but with no satisfactory response after antibiotic therapy. Bacterial, mycobacterial, and fungal culture were all negative. Histopathologic examination of the biopsy showed noninfectious suppurative panniculitis. It resolved after treatment with methotrexate, prednisone, and hydroxychloroquine. This report highlights the rarity of this complication, the importance of its early recognition, and differentiation with atypical fast growing mycobacterioses.

Mycobacterium abscessus is a rapidly growing nontuberculous mycobacterium existing extensively in water, soil, and dust that causes infections of skin, soft tissue, respiratory, and central nervous system by direct contact with contaminated material or water.1 The incidence of cutaneous M abscessus infection has increased in the past decade. Most reported cases were associated with trauma, surgery, or cosmetic procedures, including autologous fat injection, mesotherapy, tattooing, and even hair transplantation.2,3 We report 2 cases of M abscessus infection associated with facial injection of botulinum toxin (BTX) in patients who were immunocompetent.

Objective To evaluate the feasibility and effectiveness of mesotherapy in dogs compared with a positive control group. Study design Experimental, randomized, blinded study. Animals Fifteen working police dogs with chronic back pain. Methods Animals were divided randomly into control (CG; n = 5) and treatment groups (TG; n = 10). A combination of 140 mg lidocaine, 15 mg dexamethasone and 20 mg thiocolchicoside was administered to group TG along with a 70-day course of a placebo, administered as if it was carprofen. Carprofen was administered to Group CG for 70 days, at a dose adjusted to their weight. On day 0, an intradermal injection of Ringer’s lactate was also administered. Both groups were rested for 3 days and resumed normal activity over a 5-day period. Response to treatment, measured by the Canine Brief Pain Inventory (CBPI) and the Hudson Visual Analogue Scale (HVAS), was evaluated before treatment (T0), after 15 days (T1) and 1 (T2), 2 (T3), 3 (T4), 4 (T5) and 5 (T6) months. Results were compared using a Mann–Whitney test or a paired samples t test. Results When comparing CBPI results, no differences were found between groups TG and CG at T0 through T3 and in T6 and T7. Differences were observed in CBPI sections after the discontinuation of carprofen: at T4 [p = 0.02 for Pain Interference Score (PIS) and p = 0.03 for Pain Severity Score (PSS)] and T5 (p = 0.16 for PIS and p = 0.03 for PSS), with group TG having overall better results. Individual treatment results were considered successful in one dog of group CG (20%), whereas in group TG, success was higher (ranging from 78% at T1 to 22% at T7). No significant differences were registered with the HVAS. Conclusions and clinical relevance Mesotherapy may be a promising treatment option for canine musculoskeletal-related pain. Further studies are required.

This study aimed to compare 2 protocols for the management of back pain in police working dogs. Twenty animals were signaled based on history, trainer complaints, physical and radiographic examination consistent with back pain. In a retrospective study, 2 groups were considered: GM, treated with a solution comprising a combination of lidocaine, dexamethasone, and tiocolchicoseide; and GT, treated with the same solution, with the addition of Traumeel LT. Response to treatment, measured by the Canine Brief Pain Inventory (CBPI, divided into pain interference score - PIS, and pain severity score - PSS) and Hudson Visual Analogue Scale (HVAS), was evaluated before treatment (T0), after 15 (+15d) days and 1 (+30d), 2 (+60d), 3 (+90d), 4 (+120d), 5 (+150d) and 6 (+180d) months. Results were compared using an independent samples t-test or a Paired Samples t-test. Comparing results for each moment with T0 within each group, differences where observed only in GM at +15d (P.01 for PIS and P.01 for PSS), +30d (P = .04 for PIS and P.01 for PSS), +60d (P = .03 for PIS and P = .02 for PSS) and +90d (P = .02 for PSS). Treatment was successful in reducing PSS (reduction of ≥1) in 8/10 animals of GM at +15d (80%), 8/10 at +30d (80%), 5/10 at +60d (50%), 4/10 at +90d (40%), 3/9 at +120d (33.3%) and 2/9 at +150d -+ 180d (22.2%). In GT, treatment was successful in 1/10 at +15d -+30d (10%), 2/10 at +60d (20%) and 1/10 at +90d (10%). No differences were observed with HVAS any time point for either intervention or when comparing groups in each moment. The protocol used in GM produced significant improvements, while the addition of Traumeel did not, rather reducing the effect of treatment in working dogs with back pain. Further studies are required.

Mesotherapy, microneedling, and chemical peels are minimally invasive techniques used to combat facial aging. Chemical peeling is one of the oldest methods of facial rejuvenation. By using different chemicals in various combinations, strengths, and application techniques, plastic surgeons can tailor a patient's treatment for optimal, safe, and consistent results. Mesotherapy and microneedling have emerged in the plastic surgery literature with increasingly complex indications. Both techniques have increased in popularity although research into efficacy and long-term results is lagging. With a thorough understanding of patients and the modalities available, plastic surgeons can use the appropriate minimally invasive technique to provide patients with desired skin changes.

Cellulite is a multifactorial condition induced by topographic alteration of skin giving rise to ‘orange peel’ appearance. It is a universal aesthetic problem affecting 85% of post pubertal females. The present article provides an exclusive overview of all aspects related to cellulite, including its clinical manifestation, etiology, pathophysiology, evaluation and classification. Approaches for reducing cellulite appearance are innumerable. Conventional therapeutic strategies and modern practices such as physical, mechanical methods - including subcision and mesotherapy- and pharmacological agents, oral and topical routes, are reviewed. Novel delivery systems based on nanocarriers incorporating anti-cellulite agents developed in the past decade have been enumerated and analyzed for their efficacy in delivering drugs to target sites. Two main carrier based systems have been reviewed; lipid and polymer based carriers. Methylxanthines, specifically caffeine, has been critically evaluated due to its lipolytic effect of fat cells through inhibition of phosphodiesterase enzymes. The main challenge of this active moiety is its inability to penetrate the closely packed lipophilic stratum corneum. Its incorporation in such delivery systems have shown promising results in its bioavailability and efficacy. However, despite the utilization of nanocarriers in achieving targeted drug delivery has been demonstrated, yet its application in this indication has emerged recently and is limited. It is anticipated that this is a golden opportunistic research area to be exploited and developed.

Although exact statistics are lacking, body modifications for cosmetic purposes are performed in many countries. The commonest forms include tattooing, body piercing, and breast and facial augmentation using implants or injectable fillers. Liposuction and, to a lesser extent, mesotherapy are also practiced in many countries. Infective complications of these procedures include local infections, transmission of bloodborne pathogens (viral hepatitis and human immunodeficiency virus), and distant infections such as infective endocarditis. Presence of foreign bodies, long healing time of piercing wounds, and poor compliance with infection control practices of some practitioners all predispose the recipients to infections. Apart from the endogenous microbial flora of the skin and mucosae, atypical mycobacteria, especially the rapid growers, have emerged as some of the most important pathogens in such settings. Outbreaks of infection are commonly reported. We hereby review the current knowledge of the topic with specific focus on infections associated with tattooing, body piercing, breast augmentation, mesotherapy, liposuction, and tissue filler injections. Greater awareness among consumers and health-care professionals, as well as more stringent regulations by the health authorities, is essential to minimize the health risks arising from these procedures.

Aim of the study The goal of this study was to evaluate the efficacy of mesotherapy treatment with Ephedra and green tea extract in combination on localized fat of overweight women subjects. Materials and methods Twenty-five overweight women, 20–35-years-of-age, body mass index ≥ 23 kg/m2 were randomly assigned into active (Ephedra + green tea, n = 13) and placebo (saline, n = 12) groups. A total eight herbal or saline mesotherapy administrations were performed into the thighs alternatively in two phases, each one comprising of four consecutive treatments on one thigh on weekly basis. Body composition parameters, circumference and subcutaneous fat area of thighs were measured before and after each phase, in addition to evaluating fasting free fatty acid (FFA) level of blood as well as adverse events of the therapy in volunteers. Results There were no significant changes in the body weight, BMI, body fat, and subcutaneous fat area of thigh within or between the groups, but the change in thigh circumference within the active group was significantly lower compared to that within the placebo group. The blood FFA level at 1 h after the first herbal therapy was significantly higher than that recorded at other time points of pre- and post-treatment measurements. Conclusions The herbal mesotherapy treatment produced a significant effect on thigh circumference and fasting-FFA level within the active group. Future studies that compensate for the limitations of this trial are required to fully ascertain the efficacy and safety of the proposed mesotherapy, and a very careful consideration is needed until then.

Introduction In February 2009 an outbreak of subcutaneous abscesses due to Mycobacterium abscessus was detected in Spain which affected healthy women who had undergone mesotherapy procedures in an aesthetic clinic. Methods Epidemiological research, health inspection and microbiological studies were conducted. The patients were given antibiotic treatment (according to susceptibility testing) with clarithromycin, and in some cases, combined with amikacin. Results Seventeen out of 77 patients treated in the clinic were affected. The products used for the injections were homeopathic drugs in multi-dose vials. The environmental samples were negative. The sterile injection equipment and the clinical procedures were evaluated as correct. The storage conditions for the drugs were also correct, and all the samples tested negative for Mycobacteria. However Paenibacillus provencensis was isolated from samples of unused multi-dose vials and the withdrawal of the product from distribution was ordered. Deficiencies were detected in the sterile products process of at the homeopathic drug factory, so the production line was suspended. Conclusions The results of environmental investigation suggest the most likely cause of the outbreak could have been the contamination of the products in the factory, although there was no laboratory confirmation. The widespread use of homeopathic products in invasive procedures requires extreme control during the manufacturing, handling and packaging process. It is important to consider mesotherapy and parenteral use of homeopathic medicines as potential sources of infection and therefore the same precautions in the procedures and quality assurance of products should be applied as with any other drug or medical activity.

This review presents mechanisms of action and a review of the clinical applications of injections currently in development for localized fat reduction. After being received with initial enthusiasm earlier in the decade, mesotherapy and other injectable methods for fat loss (Lipodissolve, PC/DC, DC, injection lipolysis, adipolysis) have been subjects of critical scrutiny by the media and the US Food and Drug Administration. Several medications with novel detergent and lipolytic activity are in development and have demonstrated potential as minimally invasive fat reducing treatments.

Introduction: Skin and soft tissue infections caused by nontuberculous mycobacteria (NMT) are reported to be associated with injections, liposuction, plastic surgery, and acupuncture. Herein, we describe an outbreak of soft tissue infection due to NMT following mesotherapy, a cosmetic procedure involving injection of poorly defined mixtures alleged to reduce local adiposity. Methods: Patients with skin lesions and a history of mesotherapy treatment, who visited the dermatology department of the public hospital in Barinas, Venezuela, from November 2004 to February 2005 were interviewed. Clinical and environmental samples were taken for mycobacteria isolation. Results: The interviews revealed that 68 patients who had been treated for cosmetic purposes at the same clinic by the same therapist had received injections with the same product and were infected with NMT. Clinical specimens from 5 patients grew Mycobacterium abscessus. No mesotherapy solution was available for analysis but M. abscessus was isolated from an environmental sample in the clinic. PCR-based strain typing techniques (ERIC-PCR, BOXA1R and RAPD) showed that the patient’s isolates were undistinguishable from each other but different from the environmental isolate. www.elsevier.es/eimc

Introduction/Background The treatment for facial palsy is complex and requires specialized units as well as a multidisciplinary team to assess the patient globally and respond to the problems of each phase. To unify criteria and define the best treatment for each phase of the facial palsy, to improve facial function and quality of life. Material and method Both doctors and physical therapists from the Facial Palsy Units from the Rehabilitation Services of two university hospitals in Barcelona, Spain, got together to revise scientific articles, share clinical experiences and introduce new technique for facial palsy management. Afterwards, a consensus document was created as a protocol for both medical centers. Results Consensus on best treatment for each phase was achieved, as follows: – hypotonic phase: neurosensory stimulation through Perfetti method, proprioceptive and cognoscitive activities with neurosensory feedback, and movement induction by neuromuscular training (ill side). Treatment with botulinum toxin helps diminish hypercontractility of the sound side; – initiation of movement: neuromuscular training and Perfetti's neuromuscular stimulation; – synkinetic phase: neuromuscular retraining with dissociated movements of the synkinetic muscles. Relaxation treatment of the maintained muscle contractures. Treatment with botulinum toxin helps control aberrant movements and induces facial symmetry. Myofascial techniques (dry needling and mesotherapy) may help diminish maintained muscular contraction. After dynamic surgery, treatment must be based on the physiology of the reconstruction implemented, inducing movement according to the given nervous stimuli. In congenital/obstetric palsies, treatment will be similar to that of adults’ Bell's palsy, adjusting treatment to patient's age. Conclusion We believe this consensus will allow for a better clinical practice, to offer the patient the best treatment to improve functionally, mentally and socially, thus improving quality of life.

Cellulite is a topographic skin change that is nearly ubiquitous in postpubertal women. Treatment remains elusive. The various treatments currently available are only partially or temporarily effective. Newer therapeutic modalities continue to evolve without much understanding of the complex nature of cellulite. The successful treatment of cellulite will ultimately depend upon our understanding of the pathophysiology of cellulite adipose tissue. Part I of this two-part series on cellulite reviews how the concept and perception of cellulite has evolved over time and its proposed etiologies. The article also focuses on the physiology of human adipose tissue, particularly regarding cellulite.

Lipodissolve is a relatively new technique of injection lipolysis. Localized areas of fat are treated with the injection of a combination of phosphatidylcholine and deoxycholate. These agents work in concert to reduce fat deposits. The article reviews the results for patients treated with Lipodissolve and other injection lipolysis treatments by Dr. Patricia Rittes, the authors, and other practitioners and researchers. They conclude that properly performed, single-stage surgery that allows the surgeon to address all anatomic levels is preferable to Lipodissolve, pending the results of current and future studies and randomized controlled trials.

This article outlines the experience of authorities on emerging techniques in plastic surgery that are discussed within this issue, such as mesotherapy and lipodissolve, Russian threads, radiofrequency, and "laser lipo." Readers are invited to analyze the findings and determine whether there is something that could apply to their practices.

The first part of this article familiarizes the reader with the evolution of mesotherapy, injection lipolysis, and the use of phosphatidylcholine and deoxycholate for subcutaneous fat reduction. There is an emphasis on the underlying basic science of fat metabolism and the biochemistry of phosphatidylcholine, so that practitioners will be able to understand future published research on these topics. The second half details some personal experience with injection lipolysis.

The aim of this study was to evaluate the lipolytic potential of solutions used in the practice of cosmetic mesotherapy to stimulate lipolysis, cause local fat reduction and reduce the appearance of cellulite. The mesotherapy solutions were tested in a human fat cell assay using the fold induction of glycerol generation as a measure of lipolysis. The following mesotherapy solutions were tested: aminophylline; yohimbine; isoproterenol; melilotus; aminophylline with melilotus; aminophylline with isoproterenol; aminophylline with isoproterenol and yohimbine; aminophylline with isoproterenol and lidocaine; and aminophylline with isoproterenol, yohimbine and lidocaine. Isoproterenol (P

The aim of mesotherapy for skin rejuvenation is to increase the biosynthetic capacity of fibroblasts, inducing the reconstruction of an optimal physiologic environment, the enhancement of cell activity, and the synthesis of collagen, elastin, and hyaluronic acid. The desired final effect is a firm, bright, and moisturized skin, and the injection in the superficial dermis of suitable products--perfectly biocompatible and totally absorbable--can achieve these results. In addition to a daily sunscreen application and nonsmoking, mesotherapy is another antiaging strategy helping to maintain a globally firm and bright skin, protecting it from the environmental contributors to aging.

Obese individuals often suffer from negative self-image. Many, even those with a normal body mass index, resort to pharmacotherapy (lipase inhibitors or appetite suppressants), mesotherapy and surgery (gastric volume reduction, liposuction or apronectomy) in a bid to remove excess adipose tissue. These treatments are associated with inherent morbidity and even mortality, and hence should not be undertaken lightly. The observation that denervation of adipose tissue results in lipoatrophy leads us to postulate that chemodenervation using botulinum toxin may achieve the same result, i.e. fat loss, and we explore the methods by which selective fat loss may be achieved. We concede that removal of subcutaneous fat does not, however, reduce the risks associated with the metabolic syndrome, as visceral (intra-abdominal) fat is not reduced by the removal of subcutaneous fat.

Mesotherapy has recently become an advertised method for the treatment of different types of alopecia despite the lack of any data regarding its efficacy and possible side effects. The substances injected into the scalp include "cocktails" of natural plant extracts, homoeopathic agents, vitamins, vasodilators, and drugs that may stimulate hair growth, such as finasteride and minoxidil. We report two cases of patchy alopecia that developed after mesotherapy for the treatment of androgenetic alopecia. In the first patient, alopecia developed after injections of the heparinoid vasodilator mesoglycan; the 3-month follow-up examination revealed a small residual area of cicatricial alopecia. The second patient developed reversible alopecia after multiple scalp injections of homeopathic agents. These cases underline the possible risks of mesotherapy as a therapeutic technique for hair loss.

The authors of “Mesotherapy and Injection Lipolysis” state that the purpose of their article is to familiarize readers with the evolution of mesotherapy, injection lipolysis, and the use of phosphatidylcholine and deoxycholate for subcutaneous fat reduction. The article by Drs. Matarasso and Pfeifer is one of the most extensive, yet most easily understandable reviews of this subject, and it should be required reading for all plastic surgeons who perform procedures for body contour improvement.