RU2719644C1 - Method of treating local fat depots of submental area - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to dermatology, cosmetology and physiotherapy. Oxygen-ozone mixture produced in the Medosons BM plant is injected with concentration of 2000 mcg/l, according to the following scheme: centre of focus - 2 ml and radially 6 points at distance of 2 cm from the centre in volume of 1.5 ml at each point. Conic maniple of Vitalaser 500 Plus laser installation, wave length 785 nm is installed successively on treated zone. Beginning from the central point - exposure 3 min, then remaining 6 points for 1 min. Procedures are performed once a week - four procedures, then once in 2 months - three procedures. In severe cases, the course is repeated 12 months later.

EFFECT: method enables effective control of local fat depots of the submental region, prolonged clinical effect up to 24 months, the method is applicable in different age groups without limitation in the presence of a somatic pathology.

1 cl, 1 ex

Description

The present invention relates to medicine, in particular to dermatology, cosmetology, physiotherapy, and can be used in skin and venereologic dispensaries, cosmetic hospitals, in various medical and preventive and spa institutions, including in a specialized dermatological clinic.

Local body fat - the so-called "fat traps" - is the excessive development of adipose tissue in certain areas of the face and body. According to statistics, at least 46% of women and about 32% of men suffer from the problem of excess weight and body fat. The main localization of these zones in women is: the submental region, the inner surface of the shoulders, the front and side surfaces of the abdomen, the outer and inner surfaces of the thighs, buttocks, and the area above the knees. It is here that excess and subcutaneous fat accumulate faster and more often. Their localization and volume are largely fixed genetically and change relatively little during weight loss (Belousov A.E. Plastic, reconstructive and aesthetic surgery. Hippocrates. 1998; 714-716, 744. Timoshenko E.V. Correction of local fat deposits by intralipotherapy Injection methods in cosmetology. 2013; 4; 28-33.). Fat deposits are a common problem of many women, especially those who entered the Balzac age, and their changes are caused by anatomical features and changes in different layers of soft tissues of the submental region, therefore, they require the right approach, taking into account the anatomy of this zone - the structure of the lower jaw and soft tissues of the neck , the state of skin tone and subcutaneous muscle of the neck, adipose tissue volume. (N.G. Kalashnikova. Possibilities of therapeutic correction of the submental region. 2016 (2); 90-94 p.) Hardware cosmetology.). Therefore, the methods proposed for the correction of the submental region should affect several parts of the pathogenesis of this process, otherwise, you can get the opposite result - either by reducing the subcutaneous fat layer to leave excess skin, or cause uneven removal, leaving the effect of "corrugation" and so on.

Changes in the appearance lead to serious psychological problems, a decrease in social activity and the quality of life of people and require further dermato-surgical correction, which is not always possible due to the presence of often associated somatic pathology.

Resistance to existing methods of treatment, as well as age-related characteristics of patients, is characteristic, since the presence of concomitant pathology increases by this age, which leads to a limitation of the use of standard therapy and the difficulty of eliminating fat deposits in the submental region.

A known method of treatment using invasive technology is surgical liposuction in its various modifications. Despite the fact that this method is effective, the number of procedures performed decreases every year. So in 2008, about 245,000 procedures were performed in the USA, and by the end of 2009 it dropped to 198,000, which is 44% less than when the number of operations reached 2000 to 350,000 per year in 2000 (E. A. Servuli. Plastic Surgery and Cosmetology; 2013 (3); 497-503.) This dynamics is associated with a large number of side effects, postoperative complications and high mortality, which according to ML Jewell et al. Accounts for 1 in 47,000 patients (Jewell M.L., Solish N.J., Desilets C. S. Noninvasive body sculpting technologies with an highintensity focused ultrasound. Aesthetic Plast Surg; 2011 Oct; 35 (5): 901-91). The most common causes of complications are thromboembolism and fat embolism (Fatemi A. Noninvasive body sculpting devices: emerging treatments in cosmetic surgery. DERMA 2010; 1 (2)).

As a method of treating local fat deposits, a hardware method is used - Cryolipolysis, based on the destruction of fat cells - adipocytes by means of controlled cooling to a temperature of -2 + 7. It is believed that fat cells are most sensitive to cold compared to cells of other tissues. The cell dendrite formed during the decay of adipocytes is absorbed by phagocytic cells, and a local inflammatory process is initiated, which occurs within 3 days after the procedure and gains intensity by the end of the second week. The exact mechanism of selective exposure to low temperatures leading to apoptosis of adipocytes has not been fully studied. (Mulholland R.S., Paul M.D., Chaifoun C. Noninvasive body countouring with radiofrequency, ultrasound, cryolyposis, and low-level laser therapy. Clin Plast Surg 2011 Jul; 38 (3): 503-520.)

The disadvantage of this method is a long rehabilitation period, a long clinical response 4-6 months after exposure, with adipocyte apoptosis of about 25%, therefore, requires repeated use. The duration of the procedure of one zone is about 60 minutes, accompanied by pain, numbness, erythema, hematoma, and also the high cost of the procedure may appear.

There is also known a method of treating local fat deposits - radio frequency technology. The principle of operation is based on heating the tissues to a temperature of 43-45 degrees C with an electromagnetic radiation power of 25-50 watts. As a result, micro-areas (necrosis) of damage are formed, the healing of which proceeds through aseptic inflammation, which subsequently leads to a decrease in tissue volume. (Fatemi A. Noninvasive body sculpting devices: emerging treatments in cosmetic surgery. DERMA 2010; 1 (2).

The disadvantage of this method is its rather superficial effect and practically does not affect the deep layers of the subcutaneous tissue and is aimed at renewing collagen rather than destroying adipocytes, therefore, its priority application for the lifting effect, since the reduction of clinical manifestations is due to tissue tightening. Thermal damage and scarring may occur, so the technology requires surface cooling to prevent overheating of the upper layers of the skin.

Closest to the technical nature of the proposed is a method of treating local fat deposition by injection of preparations containing deoxycholate, exhibiting adipolytic activity. (Duncan DI, Chubaty R. Clinical safety data and standards of practice for injection lipolysis: a retrospective study. Aesth Surg J. 2006; 26: 575-585; Vasiliev MH How to avoid complications when using Aqualix. Injection methods in cosmetology 2015; No. 3; 95-103.), Yagina Odo M.E., Cuce LC, Odo LM, Natrielli A. Action of sodium deoxycholate on subcutaneous human tissue: local and systemic effects. Hasengschwandtner F. Detailed documentation of one lipolysis treatment: blood values, histology, and ultrasound findings. Aesthetic Surg. 2007; 27 (2): 204-211.

The disadvantage of this technology is the possibility, with local exposure, to cause an increase in the level of lipids and lipoproteins in the blood and have many contraindications for use, and it is also possible at the injection sites to develop pigmentation disorders in the form of hyperpigmentation and local pain; the need for repeated procedures and the complexity of the protocol of the procedure.

The technical result of the proposed method for the treatment of local fat deposits of the submetal region is the safe use in patients, especially with a burdened somatic history; lack of side effects of local and general; high treatment efficiency, minimum number of procedures.

The specified technical result is achieved by the fact that patients with fat deposits in the submental region, depending on the initial condition, treat the lesion with surrounding tissues, in particular, facial skin in the submental region, injects an oxygen-ozone mixture obtained with a Medozons BM 2000 concentration μg / l according to the scheme: the center of the focus is 2 ml and radially 6 points at a distance of 2 cm from the center in a volume of 1.5 ml at each point, creating a "oxygen-ozone pillow", set successively on the treated zone vayut conical laser unit handpiece «Vitalaser 500 Plus», wavelength 785 nm (the optical output power of 595 nm) from a central point - exposure 3 min, then the remaining 6 dots 1 min. In this case, the procedures are carried out 1 time per week - four procedures, then 1 time in 2 months - three procedures. The need for a repeat course in severe cases at degree 4 according to CRSFR (clinical scale of expression of the submental fatty compartment) after 12 months.

Creating an “oxygen-ozone pillow” in this zone allows you to prepare the tissue for light exposure - ozone interacts with the double bond of unsaturated fatty acids, modifying their properties, which leads to the breakdown of the lipid chain, and hydrophobic lipids turn into less stable hydrophilic;

microcirculation improves, the ability of red blood cells to transfer oxygen to tissues increases, and also due to its fibrolytic property, ozone helps to absorb some of the connective tissue structures surrounding the adipocyte, which leads to the normalization of fat metabolism. Since this process occurs against the background of the strengthening of all tissues and restoration of muscle tone, with ozonolysis there is no such negative effect observed with other lipolysis techniques as skin sagging. The skin in places of former fat deposits not only does not form folds, but also becomes more elastic and resilient. Due to the normalization of the structure of connective tissue, elimination of nodular formations, a uniform distribution of subcutaneous fat occurs, which also significantly improves the appearance. Consistent laser exposure enhances lipolysis and under the influence of ozone, leads to skin tightening.

The Vitalaser 500 Plus conical manipulator implements a unique development - a parabolic mirror, which is able to collect the energy of a diode laser into a powerful targeted stream and act on local reflexogenic points. The procedures are completely painless. Even with prolonged processing, the temperature of the zone of influence does not increase by more than 1 ° C.

In in vitro experiments conducted by N.R. Arroyave et al. Showed that under the influence of low-intensity laser radiation - LILR on the adipocyte culture in their membranes, the formation of temporary pores was observed through which release of deposited fats into the intercellular space occurred and, as a result, a decrease in the size of adipocytes. Membrane pore formation has been confirmed by electron microscopy and is specific for fat cells (Jackson RF, Dedo DD, Roche GC et al. Low level laser therapy as a non-invasive approach for body countouring: a randomized, controlled study. Lasers Surg Med 2009 Dec; 41 (10): 799-809. EM Rakhanskaya. Hardware methods of body shaping: how fat cells die. Hardware cosmetology, 2015 (3) 62-72).

The main advantage of the application is the effect on several tissue levels and pathogenesis links, as well as immediately fixing the effect by oxygen donors, followed by reorganization of the dermis (Pelle M, Crawford G, James W: Rosacea: II. Therapy. J Am Acad Dermatol 51: 499, 2004 [PMID: 15389184]).

DESCRIPTION OF THE METHOD

In the proposed method for the treatment of patients with fatty deposits in the submental region, depending on the initial state, the lesion is treated with surrounding tissues, in particular, facial skin in the submental region is injected with an oxygen-ozone mixture obtained at the Medozons BM installation with a concentration of 2000 μg / l according to the scheme: the center of the focus is 2 ml and radially 6 points at a distance of 2 cm from the center in a volume of 1.5 ml at each point, the conical manipulator of the Vitalaser 500 Plus laser unit, length wave 785 nm, (optical output power 595 nm) starting from the center point - exposure 3 minutes, then the remaining 6 points for 1 minute. In this case, the procedures are carried out 1 time per week - four procedures, then 1 time in 2 months - three procedures. The need for a repeat course in severe cases at degree 4 by CRSFR after 12 months.

This method is applied without additional treatment methods, i.e., in its pure form. Patients performed daily hygienic treatment of facial skin with skin-type products without additional lipolytic therapeutic agents.

EXAMPLES OF IMPLEMENTATION OF THE METHOD

Example 1. Patient A., 38 years old, with a diagnosis of skin-fat deformity of the submental neck region of moderate severity 2 according to CRSFR. Upon receipt - complaints of a second chin. On examination: deformation morphotype of facial aging with an edematous component according to II. Kolgunenko, Fitzpatrick’s II phototype, skin turgor and skin elasticity are moderately reduced, there is a slight excess of skin in the cervical-chin angle, subcutaneous subcutaneous fat hypertrophy is moderate, 2 cm skin-fat fold with an additional transverse fold under the lower jaw There is no pronounced change in tone with the formation of cords of the subcutaneous muscle of the neck. The duration of the condition is 5 years, without visible improvement from the treatment (cryolipolysis, lipolytic mesotherapy). Anamnesis without features. According to the patient, she considers herself healthy, does not consist of a dispensary, has not taken any drugs in the last 6 months (except vitamins). Given that the deformation of the submental region is due to excess fat deposits and a decrease in tissue tone, it is necessary to carry out treatment aimed at correcting both components, since if you reduce only the volume of adipose tissue, excess skin will remain and this will result from the ineffectiveness of the therapy. Therefore, in the beginning we create an “oxygen-ozone pillow”, after which we carry out laser therapy, which provides not only a lipolytic effect, but also an increase in the tone of the skin and subcutaneous connective tissue structures - holding ligaments and fascial plates.

The patient in the supine position was treated with a disinfecting solution of the submental region - an alcohol solution of chlorhexidine, then an oxygen-ozone mixture was injected using a Medozons BM installation at a concentration of 2000 μg / l according to the scheme: center of focus - 2 ml and radially 6 points at a distance of 2 cm from the center in a volume of 1.5 ml at each point, a conical manipulator of the Vitalaser 500 Plus laser unit, a wavelength of 785 nm, was installed sequentially on the treated area, starting from the center point — the exposure was 3 minutes, then the remaining 6 points were 1 minute each. In this case, the procedures were carried out in the following mode: 1 time per week - four procedures, then 1 time in 2 months - three procedures. The regression of clinical manifestations began to be noted after the 2nd procedure and was expressed in a decrease in the severity of the submental skin-fat fold and an increase in skin turgor. After the course of therapy, a long clinical effect was observed, no side effects were observed either local or general. After the course of treatment, there were no complaints from the patient. The return of clinical manifestations within 18 months was not observed.

Example 2. Patient B., 58 years old, with a diagnosis of skin-fat deformity of the submental region of the neck, degree of severity 4 by CRSFR. Upon receipt - complaints of a second chin and excess skin. On examination: a mixed morphotype of facial aging according to I.I. Kolgunenko, Fitzpatrick’s II phototype, skin turgor and skin elasticity are sharply reduced, there is a pronounced excess of skin in the cervical-chin angle, clear hypertrophy of the subcutaneous fat of the submental region, a 3.5 cm skin-fat fold with an additional transverse fold under the lower jaw, the tone of the subcutaneous muscle of the neck has pronounced changes with the formation of cords. The duration of the condition is 12 years, with no visible improvement from the treatment (injection treatment methods), after which she noted the appearance of excess skin and the relief of this area. A history of hypertension III degree of FC I according to NYKA, takes daily atakand 16 mg 1 time per day, pradax 150 mg 2 times a day, omacor 1000 mg 1 time per day.

The patient in the supine position was treated with a disinfecting solution of the submental region - an alcohol solution of chlorhexidine, then an oxygen-ozone mixture was injected using a Medozons BM installation at a concentration of 2000 μg / l according to the scheme: center of focus - 2 ml and radially 6 points at a distance of 2 cm from the center in a volume of 1.5 ml at each point, the conical manipulator of the Vitalaser 500 Plus laser unit, a wavelength of 785 nm, was set sequentially on the treated area, starting from the center point - the exposure was 3 minutes, then the remaining 6 points were 1 m n. In this case, the procedures were carried out in the following mode: 1 time per week - four procedures, then 1 time in 2 months - three procedures. The regression of clinical manifestations began to be noted after the 3rd procedure and was expressed in a decrease in the severity of the submental skin-fat fold and an increase in skin turgor. After the course of therapy, a long clinical effect was observed, no side effects were observed either local or general. After the course of treatment, there were no complaints from the patient. The return of clinical manifestations within 18 months was not observed.

The proposed method of treatment was applied in 122 patients suffering from localized submental fat deposits aged 27-63 years, among which the severity of the submental fat compartment on the CRSFR scale of 2 degrees (moderate) was observed in 31 patients, 3 degrees (expressed) in 53 patients and 4 degrees (pronounced) - 38 patients.

All patients showed good tolerability of the procedures, adverse reactions were not observed. All patients showed a positive dynamics of clinical manifestations - a decrease in the skin-fat fold, a reduction in the skin, an increase in its tone, i.e., optimization of the profile of the submental region and a horizontally oriented contour, which was positively reflected in the psychostatus of patients. Clinical remission ranged from 18 months to 24 months.

Indications for the appointment of the proposed method of treatment are: local fat deposits of the submental region, torpid to previous treatment, in patients with a burdened somatic history who are contraindicated in the use of surgical methods of correction and injection adipolypolysis.

The achieved therapeutic effect lasts from 18 months to 24 months.

In addition, this method allows patients to exclude invasive methods and, accordingly, to avoid its side effects.

The proposed method for the treatment of patients with local submental fat deposits compared with other therapeutic methods has higher therapeutic efficacy (90.2%) and retains a long-term clinical effect for up to 24 months, and allows its use in different age groups without restriction in the presence of somatic pathology .

No complaints were made during the course of treatment or after.

The proposed method of treatment differs in comparison with the known simplicity of the technique, good tolerance to patients and the possibility of its use in outpatient, inpatient and spa facilities.

This method of treatment was used without additional treatment methods, i.e., in pure form.

Claims (2)

    1. A method of treating local fatty deposits of the submental region, including treating the lesion with surrounding tissues, characterized in that they inject the oxygen-ozone mixture obtained at the Medozons BM installation with a concentration of 2000 μg / l, according to the scheme: center of the lesion is 2 ml and radially 6 points at a distance of 2 cm from the center in a volume of 1.5 ml at each point, the conical manipulator of the Vitalaser 500 Plus laser unit with a wavelength of 785 nm is installed sequentially on the treated area, starting from the center point - exposure is 3 minutes, then the remaining 6 points to 1 min, while the procedure is carried out 1 time per week - four procedures, then 1 time in 2 months - three procedures.     2. A method for treating local submental fat deposits according to claim 1, characterized in that in severe cases the course is repeated after 12 months.