SCIENCE SECTION

16 A ME R I C A N J OU R N A L OF ME S OT H E R A P Y
As promised, we are going to discuss the best mesotherapy meth-
ods and cocktails.
This condition is caused by excessive growth of fat pads
under the lower eyelids. It affects almost everyone after the
age of 50 and responds well to mesotherapy. Factors such as
gender, age and ethnicity do not influence the treatment out-
come. What really matters is the formulation of drugs used and
the technique.
Well begin by reviewing lower eyelid eyepads.
The injection technique involves a perpendicular
injection into the eye pad with a 3/4- inch (or similar length)
30-gauge needle. You may inject it all with one injection or
deliver the formulation via 2 seperate injections.
I personally prefer a less flexible, higher gauge needle. It is
essential not to enter the eyeball. Too flexible of a needle may
self direct toward the eye. If the eyeball is injected, it will result in
the loss of the eye. Unfortunately, some doctors are providing
The treatment for eye
pads revealed
instruction on how to inject eye pads with the needle directed
straight toward and under the eye. Do not use that technique.
Now well discuss the drug formulation for the proce-
dure. Everyone uses the same drugs but the composition
may vary depending on the phosphatidylcholine / sodium
deoxycholate (PC/DC) quantity used.
Recent research carried out in the United States showed
that DC is the main chemical responsible for dissolving fat.
For that reason, some might suggest using only DC in this
procedure. However, injecting only DC is very painful for the
patient. Therefore, I recommend using a PC/DC mixture that is
readily available from any compounding pharmacy. The amount
of DC in any strength PC solution is the same so use the low-
est strength PC solution. I use 50 mg PC/1 cc.
Now we will prepare our mixture or cocktail. I recommend
using a mixture of 1 cc of PC 50 mg/1cc plus 1 cc 2% lidocaine.
Inject 50% of the mixture on each side using a lateral approach.
First, insert the needle then start slowly injecting while gradu-
ally withdrawing the needle.
Aleksy Dobradin, MD
Lower eyelid eyepads
This is the wrong way to do this procedure and it is
very dangerous.
17 S C I E N C E S E C T I ON
Some clinicians recommend adding 1 cc (25 mg/1 cc) of ami-
nophylline to the cocktail. What I like to do is replace lidocaine
with 2% procaine. One word of caution, howeverbefore us-
ing procaine, perform an allergy test. With a tuberculin or insu-
lin syringe, inject a small amount of procaine via intradermal
injection then send the patient home. If within 3 or 4 days,
there is no skin reaction, swelling, itching, skin rash or any
other symptom of a drug allergy, you can use procaine for the
treatment.
In my opinion, Procaine is more effective than lidocaine. It
has many unique properties that have been intensely studied
all over the world. You can replace lidocaine with procaine as
long as there is no allergy issue.
If an additional treatment is required, wait another 5 to 6
weeks before performing the procedure. Advise the patient to
wear dark glasses for 1 to 2 weeks after the procedure. Expect
swelling and bruising and advise the patient accordingly.
Patients must be advised not to take aspirin or any other
medications affecting coagulation or bleeding time for 2 weeks
prior to treatment. That does not mean you cannot perform
treatment in people taking those medications. But if you do,
you can expect more swelling and bruising.
Excessive swelling can be controlled by using prednisone
in a sliding-scale manner. Perform the procedure on day 2 of
the prednisone treatment. Start with 40 mg, then lower the dose
by 10 mg every day until reaching 10 mg. Then finish by using
5, then 2.5 mg. (see the attached table). Using prednisone has
its own proponents and opponents. Consider carefully
patients medical condition before using it.
If you use the technique described here, please share your
experience with us. Send us your before and after pictures
and a description of the procedure.
Footnote:
*PC is phosphatidylcholine. DC is sodium deoxycholate.
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2004 by the American Society for Dermatologic Surgery, Inc. Pub-
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2004;30:10011008