DR JP TORRE
MesoTox: The innovation for oily and acne prone skin
Updated: May 13, 2021
MesoTox: The innovation for oily and acne prone skin
Evidence Based Aesthetic Medicine Series By Dr Jean-Philippe Torre
Micro-Needled MesoTox is a new safe treatment for oily and acne prone skin. It combines the advantages of MicroNeedling and Intra-Dermal Botulinum toxin. The superficial and homogeneous injections of low doses of toxin target the skin and not the deeper muscles (usual target for an anti-wrinkle effect). The properties of the toxin on the skin are used to improve the main factors causing Acne: sebum production, Propionibacterium acnes populations, and inflammation. It also reduces pore size and improves skin quality. The skin looks healthier, tighter and smoother.
Now available at French Touch Aesthetics, Make Me Feel and The French Pharmacy.
Botulinum Toxin (BT) is a powerful neurotoxin which administered in low doses has been used for well over two decades in a long list of therapeutic applications (52). At its most simple, BT reduces muscular contraction, the amount depending on the dose administered. It does so by blocking a specific neurotransmitter responsible for muscular contraction. This has the effect of both reducing existing wrinkles but equally preventing formation of future ones (1). We know as a result of material studies and research that BT can also inhibit other neurotransmitters (2) or target non-neuronal cells (19). BT has a high level of proven efficacy and safety (2-14) which further expand the enormous therapeutic potential of this drug, evidenced by its constantly growing list of indications (1,15,16,17,18,19,20), especially in ‘cosmetic-dermatology’.
In a series of articles, I will concentrate on the evidence available for several applications that I consider particularly interesting because of their frequency in the general population, their aesthetic impact, and their consequences on quality of life and well-being. I will, in conjunction, explain a new and more effective delivery method which will render this treatment accessible while increasing efficacy and ensuring patient safety.
Botulinum Toxin and the treatment of Oily skin and Acne
Acne alone (without considering oily skin or enlarged pores) is estimated to affect almost 10 % of the global population. It is one of the 3 skin conditions in the top 10 most prevalent diseases worldwide and represents a prolonged burden on the patients over the course of their lifetime, with important social and psychological effects (35). It is estimated, depending on the country, that between 35% to 100% of adolescents suffer from acne at a time of significant transition (51). Nevertheless, treatments proposed have not really evolved over the last three decades. Furthermore, growing antimicrobial resistance (antibiotic being largely used as an acne treatment) and adverse effects of other classic treatments (including irritation, photosensitivity, bleaching effects, or even depression…) limit their use for general application (35). A new treatment would be more than welcome.
BT is a well-known drug, used for decades, with a high level of safety, particularly when administered in the very small doses used in aesthetic medicine (2-14). As a result, new applications have developed over the time in many medical specialities, including in aesthetic medicine (reduction of ‘sad look’ linked to a downturned mouth, gummy smile, Nefertiti face lift, teeth grinding…).
Research during the last 20 years has shown that BT can be an interesting treatment for oily skin, enlarged pores and acne (see references in the appendix for more details regarding research conducted) but also other frequent problems seen in ‘cosmetic-dermatology’ which I will explore in further articles.
But its application in those indications is still very limited, the lack of a sufficiently efficient delivery system being one of the main reasons.
Concerning Acne and oily skin, their treatment using BT have not become standardized, the primary reason being probably the lack of development of an appropriate delivery method. The classic use of BT for wrinkles allows the practitioner to target the areas for treatment using a few manual intra-muscular injections. In order to effectively treat oily skin, enlarged pores or acne, an intradermal (more superficial) low dose method covering the whole face is needed. In this case, a traditional manual injection technique has several setbacks including, time and precision needed (particularly in ensuring very superficial and uniform injection of BT), and comfort for the patient given the high level of injections needed to cover the whole face.
A new efficient and safe delivery method is now available: Micro-Needled MesoTox. With this new technique, the use of an automated Micro-Needling device allows to apply BT in micro doses with surgical precision to the affected areas. Micro-Needled MesoTox is inspired by the technique described in 2019 by F Calvani and al. (36), technique to which I have made a few modifications to make it easier to handle and more effective.
Micro-Needled MesoTox has many advantages.
Professional Micro-Needling devices propose different depth settings, allowing the practitioner to propose a personalized treatment adapted to each patient skin. Those precise depth settings assure to systematically reach the intradermal level which is shown to result in best oiliness improvements than the intramuscular level (27-29). The insurance of intradermal injections also assure that only small and regular amount of BT can reach the superficial muscle fibres. It preserves the function of the underlying muscle fibres and allows to treat areas of the face generally avoided with traditional manual technique because of the risk of diffusion of neurotoxin into untargeted muscles, resulting in potential asymmetrical or unwanted results (37,38,39).
MesoTox, using a micro-needles head, allows to treat homogeneously each square centimetre of the face to get the best result possible and avoid compensatory sebum production in zones that would be otherwise less treated or not treated at all.
This new delivery method and dosages used are not associated with the same risks of bruising or frozen look classicaly feared by patients when using the traditional manual technique.
Micro-Needled MesoTox is also a great technique for patients frightened of needles: the needles are very small (micro-needles) and hidden in the head of the device.
This technique offers the possibility to add products, carefully selected and adapted to each patient case, at the same time as BT to further enhance the results of the procedure.
Finally, Micro-Needled MesoTox combines, in one treatment, the benefits of 2 procedures allowing various facial improvements:
· MicroNeedling is a well-known and widely studied treatment, safe for all skin types, very well tolerated and with very low downtime. It increases the local microcirculation (better tissue metabolism and nutrition, more growth factors, better vitality), improves the regeneration power of the cells, the collagen and elastin production, and breaks fibrosis tissue. It results in a thicker and more elastic and tightened skin. It also improves facial laxity and sagging skin, fine lines and wrinkles, acne and facial scarring, enlarged pores, sun damages, stretch marks, age spots and dark circle under the eyes (40-50). it creates temporary micro-channels enhancing (200 times) the absorption of topical products applied during the treatment to further improve the results of the procedure.
· Intra-dermal Botulinum Toxin is a safe and efficient treatment reducing facial pores size, having an anti-itch and anti-inflammatory effect and decreasing oiliness (improving dermatologic problems associated). Various other interesting effects have been described (18): improvement of cutaneous elasticity, pliability and viscoelastic properties, better wound healing, reduction of the thickness of hypertrophic scars, anti-photoageing potential… Furthermore, combined with micro-needling technique, the small quantities of BT injected intradermally relaxes the superficial muscle fibres and can bring a mild and natural anti-wrinkle preventive effect.
The frequency of oily skin problems and the burden associated with Acne deserve all our consideration. A new Acne treatment is needed. Micro-Needled MesoTox is a great option considering the positive effects of Botulinum Toxin on oily skin, its high safety profile and the advantages of this new delivery method. Patients who have tried other treatments without success can now benefit from this new technique.
Now available at French Touch Aesthetics, Make Me Feel and The French Pharmacy.
Dr Jean-Philippe Torre
Background of research underpinning efficacy of BT for Oily Skin and Acne
To the best of my knowledge, the first references concerning the interest of BT in oily skin can be found in a patent filled twenty years ago by the by Louisiana State University and Agricultural and Mechanical College (21). In this patent, the authors affirm they have discovered that ‘botulinum toxin can be used to inhibit the cascade of events that lead to acne’. According to them the result comes from the capacity of BT to inhibit the activity of the sweat gland (consequently decreasing the growth of Propionibacterium. acnes which have an important role in acne), stimulate the locomotion of keratinocytes (consequently preventing the follicular occlusion by keratinocytes) and its anti-inflammatory and anti-androgens effects. They describe a drastic improvement lasting for months after the injections of BT on 3 patients with recalcitrant acne. In a review in 2004, C.Zouboulis concludes, after examination of published material on the subject, that future drugs used to treat Acne should reduce sebum production, Propionibacterium acnes populations, and inflammation (22), which are, interestingly, the effects previously attributed to BT. A few years later, AR Shah, after noticing an improvement in skin quality in a patient treated with BT for facial lines, starts doing some research and discovers that, according to Kurzen et al. (23,24), Acetylcholine (one of the neurotransmitters blocked by BT) plays an important role in the regulation of keratinocyte differentiation, sebum production, microcirculation, and barrier protection of the skin. AR Shah then test BT intradermal injections in 20 patients complaining about larges pores and excessive sebum production. 85 % of his patients describe an improvement in skin oiliness and a decrease in facial pores size (25). The author explains the reduction of facial pores size by the effect of BT on the arrector pili muscle. It is also interesting to note that M. Roh et al. demonstrated (26) that enlarged pore sizes are associated with increased sebum output level. However, a weakness in AR Shah’s study being the lack of objective measures, in 2013 AE. Rose et al. decide to evaluate the effects of BT on 25 patients with oily skin using a satisfaction scale and a sebumeter (device used to objectively measure skin oiliness). A significantly lower sebum production was observed at 1, 2 and 3 months after BT injections, and 91% of patients were satisfied (27). The same year, Li et al. show that acetylcholine increases lipid synthesis by sebaceous glands in a dose-dependent manner, that a significative decrease in sebum production happens on the botulinum-treated side of healthy volunteers with oily skin, but that BT had no effect on the oiliness in the dry-to-normal skin group (28). Li et al. conclude that acetylcholine is a ‘promising target in the clinical management of disorders in which sebum production is increased, such as acne vulgaris’. In 2015, P. Min et al. (29), using a sebumeter on 42 female volunteers find a decrease of sebum production ranging approximately from 15% to 50% after intramuscular injections of BT. Two important findings can be highlighted: first, intramuscular injections seem to be less effective than intradermal injections used by AE Rose et al. (as intradermal injections resulted in an average reduction of sebum production of 80% at one month); secondly, sebum production is reduced at a radius of 2.5 cm around the injection site but increases beyond this limit (compensatory sebum production). It means that optimal results should be obtained by using intradermal BT injections spaced apart from each other by a maximum of 2.5cm on all the face. In 2017, after a review of treatments options for oily skin (30), DC Endly and RA Miller declare that ‘Considering the evidence and mechanism of action, intradermal botulinum toxin may be a promising treatment option for oily skin’. In 2019, L. Shuo, after reviewing the efficacy and possible treatment mechanisms of BT on oily skin conclude that BT ‘represent a promising new treatment for oily skin and other relevant dermatological problems, such as enlarged pores, acne, and seborrheic dermatitis’ (31). In 2020, K S Sayed and al. publish a split face-controlled study on 20 patients with enlarged facial pores and seborrhoea. It shows again that intradermal injections of BT significantly improve sebum secretion; and objective measures by Dermoscopy and Optical Coherence Tomography demonstrate a significant decrease in the average size of facial pores and a significant increase in dermal thickness. The authors conclude that ‘Intradermal injection of BT is an effective and safe procedure for the management of excess sebum and facial pores with acceptable results lasting for an average of 4 months’ (32). The same year, A Diaspro et al., using quantitative evaluation by skin-scanning technology, confirm the potential for skin improvement (skin texture, microroughness, and pore diameter) of intradermal injections of BT (33), and describe a high satisfaction rate among both physicians and patients. Finally, in 2021, JY Park et al., using a sebumeter and a three-dimensional scanner on 20 patients, find that intradermal injections of BT improve sebum secretion, mandibular length, facial pores and facial laxity (34).
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