Although mesotherapy had gained popularity for purposes of body contouring and weight loss, there is a tendency to disregard their various adverse effects. Adverse effects are common and depend on the product used. The most common side effects are pain, bruising, and swelling that resolve spontaneously. The most dreadful com- plication is cutaneous necrosis that is very dif fi cult to treat. Additionally, mesotherapy has been associated with atypical mycobacterial infections at sites of injections, which require antimycobacterial therapy. Other complications, such as allergic reactions, koebnerization of pso- riasis, lichenoid drug eruptions, thyrotoxicosis, and liver toxicity, will probably resolve with withdrawal of mesotherapy injections and with the speci fi c treatment of the developed disease.
Panniculitis resulting from mesotherapy may
resolve with dapsone. Other feared complications, such as scarring, can be also very dif fi cult to treat.
References
1. Alam M, Dover JS (2008) Non-surgical skin tighten- ing and lifting. Procedures in cosmetic dermatology.
Elsevier Health Sciences, Philadelphia
2. Avram MM (2005) Cellulite: a review of its physiol- ogy and treatment. J Cosmet Laser Ther 7:18 3. Bessis D, Guilhou JJ, Guillot B (2004) Localized urti-
caria pigmentosa triggered by mesotherapy.
Dermatology 209(4):343–344
4. Brandao C, Fernandes N, Mesquita N et al (2005) Abdominal haematoma – a mesotherapy complica- tion. Acta Derm Venereol 85(5):446
5. Centers for Disease Control and Prevention (CDC) (2005) Outbreak of mesotherapy-associated skin reac- tions-District of Columbia area, January-February 2005.
MMWR Morb Mortal Wkly Rep 54(44):1127–1130 6. Correa NE, Cataủo JC, Mejớa GI et al (2010) Outbreak
of mesotherapy-associated cutaneous infections caused by Mycobacterium chelonae in Colombia. Jpn J Infect Dis 63(2):143–145
7. Da Mata Jardín O, Hernández-Pérez R, Corrales H et al (2010) Follow-up of an outbreak of Mycobacterium abscessus soft-tissue infection associated with meso- therapy in Venezuela. Enferm Infecc Microbiol Clin 28(9):596–601
8. Danilovic DL, Bloise W, Knobel M, Marui S (2008) Factitious thyrotoxicosis induced by mesotherapy: a case report. Thyroid 18(6):655–657
9. Food and Drug Administration (1996) Current good manufacturing practice for fi nished pharmaceuticals.
US Department of Health and Human Services, Food and Drug Administration, Rockville, Available at:
http://www.fda.gov/cder/dmpq/cgmpregs.htm 10. Gutiộrrez-de la Peủa J, Ruiz-Veramendi M, Montis-
Suau A, Martín-Santiago A (2010) Three cases of
panniculitis due to Mycobacterium abscessus after mesotherapy. Actas Dermosi fi liogr 101(2):188–190 11. Kim JB, Moon W, Park SJ et al (2010) Ischemic colitis
after mesotherapy combined with anti-obesity medica- tions. World J Gastroenterol 16(12):1537–1540 12. Lee DP, Chang SE (2005) Subcutaneous nodules
showing fat necrosis owing to mesotherapy. Dermatol Surg 31:250–251
13. Matarasso A, Pfeifer TM (2005) Plastic surgery edu- cational foundation DATA committee. Mesotherapy for body contouring. Plast Reconstr Surg 115:
1420–1424
14. Nagore E, Ramos P, Botella Estrada R et al (2001) Cutaneous infection with Mycobacterium fortuitum after localized microinjections (Mesotherapy) treated successfully with a triple drug regimen. Acta Derm Venereol 81:291–293
15. Rose PT, Morgan M (2005) Histological changes associated with mesotherapy for fat dissolution.
J Cosmet Laser Ther 7:17–19
16. Rosina P, Chieregato C, Miccolis D, D’Onghia FS (2001) Psoriasis and side-effects of mesotherapy. Int J Dermatol 40:581–583
17. Rotunda AM, Kolodney MS (2006) Mesotherapy and phosphatidylcholine injections: historical clari fi cation and review. Dermatol Surg 32(4):465–480
18. Rotunda AM, Avram MM, Avram AS (2005) Cellulite:
is there a role for injectables? J Cosmet Laser Ther 7(3–4):147–154
19. Rotunda AM, Suzuki H, Moy RL, Kolodney MS (2004) Detergent effects of sodium deoxycholate are a major feature of an injectable phosphatidyl choline formulation used for localized fat dissolution.
Dermatol Surg 30:1001–1008
20. Tan J, Rao B (2006) Mesotherapy-induced panniculi- tis treated with dapsone: case report and review of reported adverse effects of mesotherapy. J Cutan Med Surg 10(2):92–95
21. Vedamurthy M (2007) Mesotherapy. Indian J Dermatol Venereol Leprol 73(1):60–62
22. Wanner M, Avram M (2008) An evidence-based assessment of treatments for cellulite. J Drugs Dermatol 7(4):341–345
83 A. Tosti et al. (eds.), Management of Complications of Cosmetic Procedures,
DOI 10.1007/978-3-642-28415-1_10, © Springer-Verlag Berlin Heidelberg 2012
10
10.1 Introduction
As there is an increasing demand for novel tech- nologies in the fi eld of aesthetics, challenges of the appropriate use of these technologies and safety pro fi les are important considerations to address. Advances have progressed from the once standard treatments of ablative procedures to the
very popular nonablative rejuvenation proce- dures. The latter promises to yield highly effec- tive results, without disrupting the skin’s integrity, minimal downtime, and potential for reduced adverse events (Table 10.1 ). Despite their popu- larity, general safety, and high tolerance of these devices in the most experienced hands, the pos- sibility of complications cannot be dismissed.
Adverse results can be attributed to one of many factors including physician errors by the unskilled hand and those of the patient, especially when not following the necessary posttreatment care.
Strategies for skin rejuvenation involve the essen- tial principles of cell protection, cell turnover, chro- mophore targeting, cell stimulation, tissue tightening, and volume depletion (Table 10.2 ). With consider- ations to these principles, it is imperative for the phy- sician to conduct an initial consultation discussing the patient’s medical history and cosmetic concerns in depth, the most appropriate cosmetic options that can be considered for optimal patient outcome, as well as realistic treatment outcomes and potential complications must be expli citly discussed.
In the rapidly evolving arena of aesthetic technologies, a systematic approach to the wide array of noninvasive technologies available must be applied (Fig. 10.1 ). These technologies and devices must accomplish all the essential aes- thetic goals outlined above. Indications for nonablative rejuvenation include epidermal type I and dermal type II indications. Vascular irreg- ularities, pilosebaceous changes, and alterations of skin pigment comprise type I, while consid- erations for type II rejuvenation involve deeper
Complications in Radiofrequency (RF)
Suveena Bhutani and Neil S. Sadick
S. Bhutani , M.D.
Sadick Dermatology Sadick Research Group , New York , NY 10075 , USA
e-mail: smanhas@hotmail.com
N. S. Sadick , M.D., FAAD, FAACS, FACP, FACPh (*) Weill Cornell Medical College, Cornell University , New York , NY 10065 , USA
911 Park Avenue, Apartment 1A, New York, NY 10075, USA
e-mail: nssderm@sadickdermatology.com Key Features
Complication of RF technologies are
•
often based on overheating.
Overheating is usually a result of pulse
•
stacking.
Monitoring of surface temperature -
•
keep it less than 42° C can most often avoid these sequelae.
Beware of utilizing RF technologies in
•
patients with pacemakers and prosthetic devices.
structures including subcutaneous tissue, mus- cle, and bone. Indications for treatment include skin laxity loss and redistribution of fat, muscles,
and bone and irregularities in contour and shape.
A thorough understanding of a rational struc- tural approach to whole body, noninvasive reju- venation based upon age-related correlates in the components of the dermal matrix, elastic fi bers, glycosaminoglycans, and fi broblasts may allow a physician to choose the ideal rejuvenation pro- gram with optimal safety, ef fi cacy, and patient satisfaction.