da-lieu-tham-my-tap-2

CHU BIEN:
BAN BIEN SO~
THUKY
TS.BS. Nguy~n TrQng Hao
TS.BS. Nguy~n TrQng Hao
TS.BS. Chau Van Tra
BSCKII. Nguy~n Thanh Hung
BSCKII. Ph<:tm Dang TrQng Tuemg
BSCKII. Nguy~n Thi Phan Thuy
BSCKII. Tr~n Kim Phuqng
BSCKI. Ngo Qu6c Hung
BSCKI. Ngo Duy Dang Khoa
ThS.BS. Vu Thj Phuong Thao
ThS.BS. Tr~n Nguyen Anh Tu
ThS.BS. Vu Thi Phuong Thao
ThS.BS. Ph<:tm Thj Uy~n Nhi

Chao mling quy d6ng nghi~p d~n v6i t~p san "Da Li€u ThAm My" t~p s6 2, chu d~
"Mesotherapy va cac ky thu~t tiem vi diSm"!
Trong thai gian g~n day, mesotherapy va cac kY thu~t tiem vi diSm da tra nen ph6 bi~n
nha tinh xam lftn t6i thiSu va co ths ap d1,mg r9ng rai vai nhi~u chi dinh lien quan d~n thAm
my nhu da s~n v6 cam (cellulite), t~o duang net ca thS, tich tv rna khu trli, fl,lng t6c, tre h6a
da va tang s~c t6 da. Tuy nhien, hi~n v~n chua c6 nhi~u nghien cliu lam sang gia tri ciing nhu
tai li~u t6ng quan va huang d~n chuAn v~ cac ky thu~t n6i tren.
Chinh vi v~y, chung toi xuftt ban tai li~u nay v6i mong mu6n t6ng hva thl!c hanh chuAn v~ mesotherapy va tiem vi diSm tir nhfrng dfr li~u m6i nhftt tren y van va
kinh nghi~m thl!c t~ trong qua trinh triSn khai t~i b~nh vi~n Da Li€u thanh ph6 H6 Chi Minh.
Ngoai nhfrng bai vi~t lien quan d~n chu d~ chinh nhu mesotherapy va tiem vi diSm acid hyal-
uronic, botulinum toxin, acid tranexamic, tieu ma, PRP, tiem "cocktail" ... , t~p san con c6 cac
t6ng quan c~p nh~t v~ m9t s6 tinh tr~ng da thuang g~p nhu xu tri qu~ng tham quanh m~t, ban
vang quanh m~t , mvn trung ca, loet mi~ng , tai bi~n thAm my nh~m dap trng nhu c~u da d~ng
trong dao t~o lien tl,lc va c~p nh~t ki~n thuc cua quy d9c gia.
Chung t6i xin tran trQng gi6i thi~u va rftt mong SlJ d6n nh~n va d6ng g6p nhi~t tinh cua
quy d6ng nghi~p dS nhfrng ftn ban sau c6 chftt luQTig t6t han nfra.
THAY MAT BAN BIEN SOAN
CHU BIEN: TS.BS. NGUYEN TRQNG HAO
Giam d6c B~nh vi~n Da Li€u Thanh ph6 H6 Chi Minh

IV

MUCLUC
•
•
MESOTHERAPY VA CAC KY THUAT TIEM VI DIEM ................................................................ 1
TS.BS Nguyin Tr9ng Hao
TIEM VI DIEM ACID HYALURONIC .............................................................................................. 9
ThS.BS Vu Thi Phu-ong Thew
TIEM VI DIEM BOTULINUM TOXIN ........................................................................................... 16
BS.CKI Phqm Thi Thanh Giang
TIEM VI DIEM ACID TRANEXAMIC ........................................................................................... 22
ThS.BS Trim Nguyen Anh Tu
TIEM VI DIEM TIEU M0 ................................................................................................................ 27
ThS.BS Vu Thi Phu-ong Thew
TIEM VI DIEM TRONG PRP ........................................................................................................... 35
BS. CKI DJ Thj Thanh Tam
TIEM vr DIEM vor cAc sAN PHAM "COCKTAIL" KHAc ..................................................... .4o
BS. CKI Lu- Huynh Thanh Thao
TIEM VI DIEM VOI cAc THIET Bl HO TRQ .............................................................................. .46
BS. CKJ Trdn Ng9c Phu-ong
KY THUAT MICRONEEDLING ..................................................................................................... 50
ThS.BS Le Thao Hi~n
PH6I HOP TIEM vr DIEM vor cAc KY THUAT KHAc ........................................................... 57
ThS.BS Trdn Nguyen Anh Tu
CHAM SOC DA vUNG QUANH MAT .......................................................................................... 63
BS. CKII Nguyfn Thanh Hung
THIET Bl LAN KIM VI DIEM Tlf DQNG DERMAPEN TRONG DIEU TRl NEP NHAN DA. .. 68
BS. CKII Nguyfn Thanh Hung
MUN TRONa cA: c6 ai MOI? ..................................................................................................... n
ThS.BS Phqm Thi Uyin Nhi
BAN V ANG MI MAT: CAP NHAT CAC PHVONG PHAP DIEU TRJ ......................................... 82
TS.BS Nguyfn Tr9ng Hao, ThS.BS Nguyfn Thi HJng Nhung
f.

TANG sAc TO sAu vr.EM ............................................................................................................. 90
TS.BS Nguyin Tr9ng Hao, ThS.BS Vu Thi Phuo-ng Thdo
GIAM MO KHONG xAM LAN ...................................................................................................... 98
TS.BS Nguyin Tr9ng Hao, ThS.BS Le Thdo Hidn
LASER DIEU TRl VET BAM SAU TIEM CHAT LAM DAY ..................................................... 104
ThS.BS Trim Nguyen Anh Tu
n.EP cAN cHAN DOAN THVONG TON LOET MIBNG .......................................................... 109
BS. CKIJ Nguyin Thi Phan Thuy
~
VI

MESOTHERAPY
\
/
rv
/\
/\
;(
VA CAC KYTHUATTIEM VI DIEM
TOM TAT
Mesotherapy d~i di~n cho nhfmg ky thu?t xam tim toi thi~u g6m tiem trong da ho?c dU'&i
da IU'Q'ng nh6 cac chiet xuat thlfC v?t (lf nhien, chat vi IU'Q'ng d6ng can (homeopathic agents),
thuoc, vitamin hay nhfmg chat co ho~t tinh sinh hQc khac dlJ thuc day m¢t dap &ng sinh hQc
va s&a chffa tinh tr~ng b~nh /y & vung can dieu trj. Chi djnh chinh cua mesotherapy trong
da lieu tham my/ada san v6 cam (cellulite), t~o dU'&ng net ca thlJ, tich tt,J ma khu tru, rt,Jng
toe, tre hoa da va tang scic to da. Ky thu?t nay con dU'Q'C gQi Ia tiem vi dilJm (microinjection)
trong m¢t so chi djnh, vi dt,J tiem vi di~m acid hyaluronic, botulinum toxin ... Trang nhffng nam
gan day, mesotherapy va cac ky thu?t tiem vi dilJm da tr& nen pho bien do xam tan toi thi~u,
it dau. Tuy nhien, can co them nhfrng tht} nghi~m lam sang co so sanh dU'Q'C thiet ke chuan
dlJ danh gia hi~u qua va tinh an toan cua cac san pham va ky thu?t m&i nay.
GiffiTHitU
Mesotherapy la k5' thu~t duqc bac si ngm'ri Phap Michel Pistor phat tri~n vao nam 1952
khi ong dieu tri giam dau va cac b~nh ly m~ch mau. Thu~t ngfr mesotherapy c6 ngu6n g6c
ru Hy L~p , v&i "meso" nghia la "a gifra" va "therapy" nghia la "diSu trf'. M\lc tieu diSu tri
la "mesoderm"' 16p mftm nguyen phat phat tri~n thanh mo lien k~t , CO' va h~ tuftn hoan. Ong
mo ta meso therapy la " ... it th~ tich, it lftn va vao vi tri cftn thi~t". Tir d6, ky thu~t nay duqc su
d\lng d~ dieu tri m9t s6 tinh tr~ng b~nh ly thftp hQc, chftn thuang th~ thao, nhi€m trimg, b~nh
m~ch mau va giam dau. Nam 1964, Pistor sang l~p H9i Mesotherapy Phap va d~n nam 1987,
H9i Y hQc qu6c gia Phap m&i chinh thuc cong nh~n mesotherapy la m()t chuyen nganh y khoa.
Cling h!c d6, mesotherapy tra nen ph6 bi~n a hftu h~t kh~p chau Au va Nam My va gftn day
la Hoa Ky va cac nu&c chau A.
Theo dinh nghia r()ng, mesotherapy d~i di~n cho nhfrng kY thu~t xam lftn t6i thi~u g6m
tiem trong da ho~c du&i da luqng nh6 cac chi~t xuftt thvc v~t tv nhien, chftt vi luqng dflng
can (homeopathic agents), thu6c, vitamin hay nhfrng chftt c6 ho~t tinh sinh hQc khac d~ thuc
d~y m9t dap trng sinh hQc va sua chua tinh tr~ng b~nh ly a vling cftn diSu tri. Ky thu~t nay
con duqc gQi la tiem vi di~m (microinjection) trong m()t s6 chi dinh, vi d\l tiem vi di~m acid
hyaluronic, botulinum toxin ...

Da lieu thflm my
Hi~n nay, mesotherapy truyen th6ng
da phat tri~n vao ky nguyen m6i cua thftm
my noi khoa, v6i nhfrng ung d\mg trong
dieu tr! cac tinh tn;mg lien quan d€n thftm
my nhu tieu rna, da s~n v6 cam va thon
gQn ca th~. Trang tre h6a da mesotherapy
thucmg dugc thay th€ b~ng cac thu~t ngfr
nhu: biorejuvenation, biorevitalization hay
mesolift/mesoglow.
CHi DJNH MESOTHERAPY TRONG
DA LIEU THAM MY
Mesotherapy da dugc nghien cilu nhieu
trong cac chi d!nh:
- Da s~n v6 cam (cellulite)
-
T~o duemg net ca th~
- Tich t1,1 rna khu tru
Rl,lng t6c
Tre h6a da
- Ding s~c t6 da
Mot s6 tinh tr~ng da khac cling c6 th~
cai thi~n v6i mesotherapy nhu:
- M\ln trung ca
- Cham
-
S~o h~i, s~o phi d~i
Loet chan
Lao h6a da do anh sang
- Ngua
- Yay n€n
-
R~n da
- Dan m~ch
- U tr~ tinh m~ch
-
B~ch bi€n
CHONG CHi DJNH MESOTHERAPY
C6 thai hoi;ic dang cho con bu
Dai thao duemg ph\l thuoc insulin
Tien su dot quY.
Tien su ung thu
Tien su thuyen t~c huy€t kh6i
B~nh nhan dang su d1,mg aspirin,
warfarin, heparin ...
B~nh tim ni;ing
B~nh gan hay th~n dang ho~t dong
D! ilng v6'i mot trong nhfrng thanh
ph~n cua thu6c
NHUNGSANPHAMTHUONGDUQC
SUDl)NG
Hi~n nay, c6 nhieu san phftm tren th!
truemg danh cho ky thu~t mesotherapy. San
phftm c6 th~ du6i d~ng mot ho~t ch~t duy
nh~t, hoi;ic la h6n hgp nhieu ho~t ch~t khac
nhau va dugc chQn h,ra dva vao tinh ch~t
dugc hQC. Nhieu tac gia cho r~ng tiem mot
ho~t ch~t c6 th~ cho k€t qua t6t hon tiem h6n
hgp "cocktail" vi giam nguy ca tac dl,lng ph1,1
do tuang tac gifra cac ho~t ch~t khac nhau.
Bang 1. NhCrng san phflm dung dieu tri da san v6
cam
Ly giai ma
L-carnitine,
caffeine,
iso-
proterenol
Cai thi$n h6i IU'u Rutin, aminophylline, pent-
tTnh mc;~ch
oxiphylline
Giam dau
Procaine (cOng giup cai thi$n
tuan hoc'm)
Pha va m6 lien ket
Collagenase, hyaluronidase
Dan IU'u
Artichoke, gingko biloba
Bang 2. NhCrng san ph~m dung tre h6a
Acid hyaluronic (1 ,35%- 3%)
Acid hyaluronic 0,2%, 1% hay 3% ket hQ'p v&i
nhCrng hoc;~t chat khac
Dc;~i phfm tiY polynucleotide
Silicium hCru ca
Nguyen baa SQ'i cay tl,J' than
Yeu to tang tm&ng
Chat vi IU'Q'ng d6ng can

Bang 3. NhCmg san pham diflu trj tang s<'k t6 da
Glutathione
Acid ascorbic
Acid glycolic
Pyruvate
Acid tranexamic
Bang 4. NhCfng san pham kfch thfch mQC t6c
Buflomedil
Minoxidil
Finasteride
MESOTHERAPY TIED MO
Da s~n vo cam la sv tich luy rna bftt
thu<'m,g phia tren 16-p din co, d~n d~n hinh
ant: lOi 16m tren da gi6ng vo cam, thuong
xuat hi~n a mong va dui cua phv nfr, ca
ng_uai binh thu<'mg l~n beo phi. N guo·i ta con
thay tinh tr:;tng nay xay ra do bftt thuong h~
tinh m:;tch b:;tch huy~t. Theo y van, di~u tri
tich tv ~a khu tru va da s~n vo cam b~ng ca~
ho:;tt chat neu 6' Bang 1.
C6 2 lo:;ti mesotherapy giam rna, d6 la
kich thich ly giai rna va b6c tach (ablative).
Kich thich ly giai rna dua tren SU' hoat h6a
ly giai trong t~ bao rna. co it nhfit 3 ~o ch~
thuc dfty sv ly giai rna: (1) uc ch~ enzym
phosphodiesterase hay thv th~ adenosine,
(2), ho:;tt h~a thv th~ ~ -adrenergic va (3) uc
che thv the a-2. Aminophylline, isoproter-
enal hay forskolin va yohimbine tac d<)ng
tren ca 3 each ly giai rna. Mesotherapy b6c
t~ch gay S\f pha huy t~ bao rna b~ng chftt
tay. Phosphatidylcholine va deoxycholate la
nhfrng thanh ph~n chinh trong mesotherapy
b6c tach. Phosphatidylcholine c6 th ~ :
1. Xuyen qua t~ bao rna va pha vo· rna
dua ra theo duang mau va ti~t qua
th~n va ru<)t. Vi phosphatidylcholine
la m<)t chftt nhu tuong nh~y nen de-
oxycholate duqc them vao d~ tang
hi~u qua cho ky thu~t tiem. Ho:;tt chftt
Mesotherapy va cac ky thu$t tiem vi di~m
nay c,ung duqc chung minh gay ly
giai te bao mo· m<)t each d<)c l~p .
2. Thuc dfty qua trinh tieu rna b~ng each
kich thich thl;l th~ ~ va li'C ch~ thl) th~
a hi~n di~n tren mang t~ bao rna.
3. Gay ho:;ti ru viem qua trung gian cyto-
kine va tai hftp thu t~ bao ma. Ngay khi
qua trinh viem giam xu6ng, collagen
mcua mo long leo.
Phosphatidylcholine gay ly giai mo· qua
con du<'mg ho:;tt h6a monophosphate vong
va ho:;tt h6a thv th~ ~-adrenergic. T~ bao rna
vilng dui mong c6 1t thv th~ ~-adrenergic so
v&i nhfrng vi tri khac. Deoxycholate mot minh
dUQ'C khuy~n cao Slr d1,mg trong di~u .tri tich
1\1 mo· khu tru luqng nho, trong khi h6n hqp
phosphatidylcholine va deoxycholate danh
cho vimg di~u tri l&n hon. Ngoai ra, d:;tng h6n
hQ-p se giup giam viem sau tiem nhanh hon so
v&i deoxycholate m<)t minh. Do sau cua mili
tiem dao d<)ng ttr 6 d~n 12 mm ..
Ngay 29/4/2015, FDA (Hoa Ky) da
cong nh~n Kybella (Allergan, Irvine, CA)
v&i thanh ph~n la acid deoxycholic trong cai
thi~n vung ma du&i c~m 6' nguo·i l&n.
MESOTHERAPY TRE HOA DA
Cac vimg di~u trj
M~t (rna, c~m, tran)
c6
Duang du6·i c6
Mu ban tay
Bl;lng
Canh tay, c~ng chan (m~t trong)
M~c du mesotherapy tre h6a da la mot
kr thu~t d~ thvc hi~n nhung v~n c6 nhfr~g
bat lqi nhu chi danh cho lao h6a muc do
n~y d~n Vtl'a, gay cam giac bong/ngua·,
hong ban nh(f sau tiem, t:;to ra cac v~t b~m

tv mau, nguy ca phim ung djung, thieu cac
thll' nghi~m lam sang c6 so sanh, thieu cac
huang d~n theo y hQC d\l'a vao chung CU.
Ky thu~t tiem
Ky thuijt tiem cJ tliin
Su d1.,mg kim 4 mm x 0,4 mm (27G)
cho phep tiem chinh xac trong da a b~t ky
b~ m~t da nao va cling tranh duqc cac vling
gian mao m~ch va thuong t6n da. Tuy nhien,
kim 13 mm x 0,3 mm (30G) thi thich hqp
han cho tre h6a da b~ng mesotherapy.
Mesotherapy la tiem luqng r~t nho cac
san phftm vao dung nai c~n di~u tri, theo cac
ky thu~t sau day:
-
Ky thu~t tiem trong thuQng bi (in-
traepidermal): ly tu&ng cho tre h6a
vling m~t , duqc m6 ta d~u tien bai
Perrin, la ky thu~t tiem nang nh~t ( 1
mm), kh6ng xuyen qua mang day. C6
th~ tiem a m(>t vling r(>ng l&n, kh6ng
gay dau, kh6ng chay mau, thich hqp
cho b~nh nhan c6 nguo·ng dau th~p.
-
Ky thu~t tiem t~o n6t s~n (papular):
dung d~ di~u tri nep nhan va n,mg.
Gay dau vi tiem den ch6 n6i bi -
thuqng bi (2 mm). Vi d\1 cho kY thu~t
nay la MesoBotox.
- Ky thu~t tiem ttmg giQt (picotage hay
nappage): tiem rung giQt san phftm
vao 16-p bi nang. Cac di~m tiem each
nhau 1 em va kim xuyen xu6ng 2 -
2,5 mm. Miii kim th~ng dtrng ho~c
chech g6c 45° va nen gifr lgc c6 dinh
len pit-tong bom tiem.
- Ky thu~t tiem dan cheo (cross-link-
ing): tiem theo cac duemg each nhau 1
em, ngang - dQc gi6ng hinh dan lu&i.
Tiem het chi~u dai miii kim vao l&p
bi, sau d6 wa bom san phftm wa rut
d~n miii kim ra khoi da. Ky thu~t nay
thich hqp cho vling rna va nep nhan
du&i c6 a b~nh nhan lao h6a. Gifr miii
kim lu6n chech 45°.
- Ky
thu~t tiem theo duemg (linear
threading): chi tiem theo cac duemg
dQc hay ngang. Tiem duemg dQc c6
hi~u qua trong truemg hqp chuftn bi
cho nep miii rna va nep nhan gian may
10 - 15 ngay tru&c khi tiem ch~t lam
d~y va botulinum toxin. Tiem duemg
ngang c6 hi~u qua trong di~u tri nep
nhfm c6. £)~ giam cam giac bong rat,
c6 th~ b6i EMLA cream hay su dl.,lng
san phftm mesotherapy chua lido-
caine. Gifr miii kim lu6n chech 45°.
Hlnh 1 a. Ky thu$t tiem Mesobotox t<;~o not SEin
(Nguon: Plast Reconstr Surg. 2015 Nov;136(5 Supp/):92S-100S)

Mesotherapy va cac ky thuc;'lt tiem vi di~m
Hinh 1 b. Ky thuc;'lt tiem acid hyaluronic tc:;10 not san
(Ngu6n: Khoa ThfJm my da, B?nh vi?n Da Lieu TPHCM)
Hinh 2a, 2b, 2c. Ky thuc;'lt tiem tt:Png giQt
(Ngu6n: Atlas of Mesotherapy in Skin Rejuvenation 2007)

Da lieu thcflm my
Hinh 3. Ky thu$t tiem dan cheo
(Nguon: Atlas of Mesotherapy in Skin Rejuvenation 2007)
Hinh 4a, 4b. Ky thu$t tiem theo dU'ang
(Nguon: Atlas of Mesotherapy in Skin Rejuvenation 2007)
LifU phap vi iliJm (microtherapy) va ilifn di qua da (electroporatin)
Day la nhfrng phuong phap m6'i v6'i mot
s6 uu di~m hO"D so v6'i cac k:y thu~t c6 di~n .
Li~u phap vi di~m la thu thu~t giup tiem
thu6c vao trong da thu~n lqi hon. Cac d~u
kim sieu nho dua thu6c d€n 16p bi nhu, vi
v~y tranh t6n thuO"Dg cho th~n kinh va m~ch
mau n6ng a da. Mot s6 uu di~m cua thu
thu~t nay la:
Kh6ng dau vi cac kim kh6ng ch~m
d€n th~n kinh.
-
Giam nguy co t~o v€t b~m vi kh6ng
ch~m d€n m~ch mau ben du6'i.
-
Thu6c h~p thu ch~m vi kh6ng xu6ng
d€n m~ch mau 16p bi sau va it vao
tu~n hoan, giup gifr ho~t tinh Hiu hon
t~i ch6 tiem.
-
Kh6ng t~o SlfO .
Di~n di qua da la mot phuong phap
r~t thu vi v6'i nhi~u ling d1,mg trong nganh
da li€u va thftm my. Thu thu~t nay giup
.
'·

khu~ch tan cac ho<;tt ch~t qua l6p sung, day
la l6p ngan can cac phan tu ua nu6c val
hay cac phan tl.r c6 trQng lu'Q'ng 16n di qua
da. Nguyen ly ho<;tt d()ng la gay ra cac xung
di~n tren bS mi;it bi~u m6, tu d6 t<;to n·en sv
chenh l~ch di~n th~ xu yen mang 0,5 - 1,5
v va d~n d~n hi~n tuqng di~n di cua mang
t~ bao. Cling h1c d6, xung di~n se gay nen
S\}" xao tr{)n di~n h6a 6 lap sung va lam tang
tinh th~m 16p sung. Thu thu~t kh6ng gay
dau va an toan cho b~nh nhan. H~ th6ng
g6m m9t t\1 di~n 100 V t<;to ra m9t song dao
d9ng theo quy lu~t s6 mu thu~n ngh!ch di;ic
trung va m9t bu6ng ho<;tt h6a b~ng kim lo<;ti
chua gel d~n truysn co cac phan tu ho<;tt
tinh. Cac 16 nang long di~n di cho phep
nhfrng phan ru trQng luqng l6n xuyen qua.
Kenh nu6c (1 - 2 !J,m) cho phep cac phan tu·
nhu polysaccharide trong luqng trung binh
(acid hyaluronic), peptide (collagen hoa
tan) va glucoside xuyen qua. Bu6c d:iu tien
cua qua trinh disu tr! la lo<;ti bo lap sung
b~ng vi mai mon tinh th ~, sau d6 la 19t da
n6ng. Bu6c ti~p theo la dua cac ho<;tt ch~t
(acid hyaluronic, vitamin, peptide ... ) vao
gel d~n truySn d~ duqc ion h6a trong bu6ng
ho<;tt h6a r6i di;it len vung c:in di~u tr! b~ng
each mat-xa nht;. Thu thu~t keo dai khoang
30 phut va c6 th~ li;ip l<;ti m6i 1 - 2 tu:in cho
m9t dqt di~u tri 10 I :in.
Ngoai nhfrng ky thu~t tiem c6 di~n
va tiem cai ti~n n6i tren, mesotherapy con
dUQ"C thtJC hi~n v6i cac thi~t bj hf> trq nhu
d<;tng sung (mesogun), d<;tng but (mesopen)
hay d<;tng t<;to ap lvc kh6ng kim ... Nhtmg
thi~t b! nay se gi6i thi~u chi ti~t 6 bai "Tiem
vi di~m v6i cac thi~t b! h6 trq" trong s6
chuyen d~ nay.
a
b
Mesotherapy va cac ky thu<';lt tiem vi diem
Hinh 5. Mesogun
(Nguon: Cosmetic Surgery 2013)
Hinh 6a, 6b. Mesopen
(Nguon: Cosmetic Surgery 2013)
KETLU~
Trong nhung nam g:in day, mesotherapy va
cac ky thu~t tiem vi di~m da tro· nen ph6 bi~n
do xam l~n t6i thi~u, it dau nhung cho d~n
nay, CO" ch~ tac d\mg cua nhiSu san ph~m v~n
chua ro hay con ban cai va chua c6 hu6ng
d~n ro rang v~ li~u luqng va hi~u qua cua
cac san ph~m . Tinh an toan cua cac phan til·
tiem vao da chua duqc chtrng minh, ch~ng
h<;tn phosphatidylcholine v~n chua duqc c6ng
nh~n 6 m9t s6 nai tren th~ gi6i Vi v~y, c:in c6
nhung thu nghi~m lam sang c6 so sanh duqc
thi ~t k~ chu~n d~ danh gia hi~u qua va tinh an
toan cua cac san ph~m va ky thu~t m6i nay.
7
f

Chung ta cling hy VQng se c6 nhfrng hu6ng
d~n va khuy~n cao c6 ch~t luQng lien quan
d~n vi~c ap dlfllg cac kY thu~t nay trong da
li~u th~m my.
TAl LI~U THAM KHAO
1.
De Padova MP, Fabbrocini G, Cacciapuoti S,
Tosti A. Mesotherapy. In Textbook of Cosmetic
Dermatology 5th Edition 2017, Taylor & Fran-
cis Group, LLC, pp: 431-435.
2.
lorizzo M, De Padova MP, Tosti A. Bioreju-
venation: theory and practice. Clin Derma-
to!. 2008 Mar-Apr;26(2): 177-81.
3.
Konda 0 , Thappa OM. Mesotherapy: What
is new? Indian J Dermatol Venereal Leprol
2013;79: 127-34.
4.
Lee JC, Daniels MA, Roth MZ. Mesotherapy,
Microneedling, and Chemical Peels. Clin Plast
Surg. 2016 Jul;43(3):583-95.
5.
Sarkar R, Garg VK, Mysore V. Position paper
on mesotherapy. Indian J Dermatol Venereal
Leprol2011 ;77:232-7.
6.
Tosti A, De Padova MP. Atlas of Mesotherapy
in Skin Rejuvenation, 2007 lnforma UK Ltd.
7.
Vedamurthy M. Mesotherapy in Aesthetic Med-
icine. In Cosmetic Surgery 2013, Springer, Ber-
lin, Heidelberg, pp: 205 - 218.
8.
Wu WT. Microbotox of the Lower Face and
Neck: Evolution of a Personal Technique and
Its Clinical Effects. Plast Reconstr Surg. 2015
Nov; 136(5 Suppl):92S-1 OOS

"
~
TIEM VI DIEM ACID HYALURONIC
TOM TAT
Uio h6a da Ia m()t ti~n trinh sinh hQc ph&c t?p anh hU'&ng b&i nhitJu y~u t6 n()i sinh va
ngo?i sinh. Khai ni~m vtJ s&c kh6e /an da va ve df;Jp ngay m()t nang cao, nhitJu chi~n /U'(;rc
phong ch6ng va ditJu tri tinh tr?ng lao h6a da GU'Q'C phat tri~n khong ngimg trong nhCmg
nam vifa qua. Trang nhCmg nam g~n day, vai tro cua aitJu tri tham my da mesotherapy
(tiem trong da nhCmg chat c6 ho?t tfnh dU'Q'C ly) ngay cang dU'Q'C nhan m?nh trong chi~n
IU'Q'C ditJu tri ch6ng lao h6a da. Tuy nhien, trong cac san pham d~ ditJu tri tre h6a da b~ng
mesotherapy, acid hyaluronic (AH) dong vai tr6 quan trQng trong vi~c cung cap d¢ am cho
khoang gian baa do kha nang thu hut cac phan t& nU'&c va dU'Q'C cho Ia giup t?o ra aitJu
ki~n sinh ly d~ m?ng IU'&i ngo?i baa tang sinh. NhCmg kinh nghi~m lam sang trong aitJu tri
mesotherapy b~ng acid hyaluronic cho thay r~ng ky thu~t nay an toan khi dU'Q'C thl,fc hi~n
b&i bac sr aa dU'Q'C huan luy~n.
GHJI THI~U
Theo thcYi gian va S\f ti~p xuc v6i anh n~ng m~t trai, nhfrng chile nang cua da se b! giam
di, g6m CO kha nang df>i mai t~ bao, hang rao bao V~ da, kha nang thanh lQC cac h6a chftt,
xuc giac, bao v~ co hQc, lanh v~t thuang, dap 1mg mi~n d!ch, di~u hoa nhi~t, bai ti~t m6
hoi, san xuftt chftt ba, vitamin D va kha nang sua chua DNA. Nhu m9t h~ qua tftt y~u, m9t
s6 nhfrng thay d6i nhu b~ m~t da sfrn sui, sv xuftt hi~n n~p nhan, giam kha nang dan h6i va
bi~u hi~n cua m9t s6 b~nh ly da cling duqc quan sat thfty. M9t each Cl) th~, giam t6ng hqp
va tang thoai h6a cac SQ'i collagen va elastin, giam kha nang tang sinh cua nguyen bao SQ'i
va tr~ng thai cang thing CUa m~ng luai elastin d~n d~n S\f thay df>i CaC d~C tinh CO hQC CUa
da la giam st,r dan h6i.
Lao h6a da la vftn d~ rftt duqc quan Him trong xa h9i van minh hi~n nay, nhftt la Hio h6a
da a m~t. Day la m9t ti~n trinh phuc t~p, lien quan d~n 2 y~u t6 quan trQng: Sl)" giam th~ tich
thong qua guong m~t va do cu· d9ng l~p di l~p l~i cua cac co d~n d~n Sl)" hinh thanh nSp nhan
va ranh nhan. Theo truy~n th6ng, tre h6a da t~p trung vao cac quy trinh th~m my nhu: laser
C02 tai t~o b~ m~t, vi bao mon va kich thich di~n lam san xuftt collagen tu nguyen bao sqi.
Trong d6, ky thu~t tiem vi di~m acid hyaluronic duqc ling dl)ng r9ng rai nha vao nhfrng uu
di~m va hi~u qua rna n6 d~t duqc trong di~u tr! tre h6a da [3l.

Da lieu tham my
TIEM VI DIEM
Mesotherapy (tiem vi diem) la Icy thu~t
tiem trong da nhfrng ch~t c6 ho;;tt tinh duQ·c
ly nhu ch~t dinh duang, hormone, vitamin,
enzyme va nhfrng ch~t ho;;tt h6a khac, duvc
hoa tan va dua tn,rc ti~p vao vi tri dieu tri.
Tru6'c day, mesotherapy dugc phat trien de
di~u tri cac r6i loan mach mau va b;;tch huy~t,
g~n da~ con dug~ lin~ dvng trong di~u tri tre
h6a da. Phuong phap nay bao g6m vi~c tiem
vao trong da cac san phclm c6 ho;;tt tinh sinh
hoc nh~m tfmg cuemg d(> elm va con giup tai
t;;t.o l;;ti m6i tnr011g sinh hQc t6i uu nh~t cho
nguyen bao sgi. Di~u nay hu6'ng t6'i vi~c gia
tang ho;;tt d(>ng t~ bao va t6ng hqp collagen,
elastin va hyaluronic acid. C6ng thlic ph6
bi~n nh~t cua mesotherapy de di~u tri tre h6a
da mat la vi~c tiem l~p l;;ti vao trong l&p bi
n6ng .dung djch da vitamin, cac ch~t c6 ho;;tt
tinh sinh hQC Va dUQ'C h~p thu.
Mvc dich cua mesotherapy trong di~u
tri tre h6a da la duy tri va/hay kh6i phvc l;;ti
du true tre trung va khoe m;;tnh cua lan da.
Hi~u qua mong mu6n la d;;tt dug~ m(>t Ian da
ch~c khoe, tr~ng sang va du d(> am.
M(>t vai nghien cliu thl,fc nghi~m d~ cho
th~y hyaluronic acid tiem trong da c6 the kich
thich nguyen bao sQ·i bieu 19 collagen type 1
(Col-1 ), matrix metalloprotease-1 (MMP-1)
va ch~t lie ch~ mo CUa matrix metallopro-
teinase-1 (TIMP). Chinh vi v~y, vi~c tiem vi
diem acid hyaluronic trong da li~u thclm my
ngay cang dUQ'C ling d\tng r(>ng rai. [3]
ACID HYALURONIC
Acid hyaluronic dugc chi~t xu~t rir thuy
dich cua m~t bo bai Karl Meyer va c(>ng S\l'
J~hn Palmer l~n d~u nam 1934. Day la m(>t
chu6i polysaccharide va c6 the hi~n di~n
du&i nhi~u ten khoa hQc nhu:
J(
10
~
· +
Tim
I Ghi chu -linh VlfC U>ng d1,mg
Hyaluronic acid
Meyer va Palmer
1934- thuoc
Na-hyaluronate
Muoi pH trung hoa - dU'Q'C
Hyaluronan
Balazs va CQng Sl,l' - khoa hQC
Natrii hyaluronas
Thu$t ngCP Latin - dU'Q'C
C~u true boa hQc
C~u true h6a hQC cua acid hyaluronic
(AH) dt don gian: dan vi disaccharide c6
chu·a acid glucuronic vaN -acetylglucosamine.
Acid hyaluronic con dugc djnh ngh1a la m(>t
glycosaminoglycan v&i chu6i polysaccharide
kh6ng phan nhanh, t6ng hgp rir hang nga?
phan 1ir disaccharide. Trang thl,fc nghi~m, tat
ca nh6m carboxylic cua acid glucuronic va
N-acetylglucosamine d~u duqc ion h6a, lam
cho phan 1ir acid hyaluronic c6 tinh phan eye
cao va do d6 d~ tan trong nu&c. Nha d~c diem
nay, acid hyaluronic c6 the k~t hqp ~6'i nhi,~u
phan tlr nu6'c va d;;tt hi~u qua cung cap d(> am
cao.
H
Hinh 1. Cau true phan tU> acid hyaluronic
(Ngu6n: Marina Romagnoli, Magda Belmontesi.
Clinics in Dermatology. 2008;26: 123-159)
TrQng luQ·ng phan tfr
AH la m(>t phan ru d6ng d;;tng, d;;tng
duong, du thanh rir nhi~u dan vi disaccha~ide.
Cac d;;tng dung djch AH khac nhau chi ve d(>
dai va trQng luqng phan tlr, vi dv trQng luqng
phan ru AH trong ho;;tt djch thuemg giam a
b~nh nhan c6 b~nh ly v~ kh&p. 6 cac m6 khoe

m£;tnh, tr9ng lugng phan ru AH ru 5-10 tri~u.
Trong m()t s6 mo va loai, d~c bi~t trong m()t s6
b~nh ly tr9ng lugng phan ru AH co th~ du6i 1
tri~u. Tr9ng lu9ng phan tlr cac san ph~m AH
tren th! trnemg thuemg ru 0,5-5 tri~u.
I>{) dai phan tfr
Tr9ng lugng va d9 dai phan tlr AH tuy
thu()c vao s6 don vi polysaccharide co trong
chu6i. Chi~u dai chu6i cling khac nhau 6
cac mo va toai khac nhau nhung hfru hSt la
my thu()c vao tinh tr£;tng mo. Trong mo binh
thucmg, m()t phan ru AH n~ng 10 tri~u co d9
day khoang 1 nm va dai 25 IJ.m.
Nfing d{) trong mo
Trong tfrt ca mo, AH la thanh phfrn thiSt
ySu cua m£;tng lu6i ngo£;ti bao. AH co n6ng
d9 cao 6 cac mo nhu cu6ng r6n (4 mg/g),
dich kh6p (3-4 mg/mL) va thuy dich (0,1-
0,4 mg/g). N6ng d9 trung binh cua AH ta
200 mg/kg (0,02%). M9t nguai n~ng trung
binh 60 kg co chu·a khoang 12 g AH.
Bang 1. N6ng dQ acid hyaluronic trong m6
St,Jn
Da
Phoi
1200
200
150
Khac
I Acid hyaluronic (mg/l)
Huyet thanh
Trang te baa
Tat ca m6
0,05
Kh6ng c6
200
M~c du AH co n6ng d9 cao trong mo lien
kSt, phfrn 16n AH (56%, 7g) la 6 da.
Chuy~n boa
Sinh t6ng hqp va chuy~n hoa AH la duy
nhfrt. Sinh t6ng hqp AH la m9t qua trinh
enzyme phu·c t£;tp trong mang tS bao va thu
th~p cling nhu thoai hoa duqc di~u hoa b6i
Tiem vi diem acid hyaluronic
cfru n6i v6i m()t receptor, sau do la sv thoai
hoa n9i bao. Qua trinh nay rfrt nhanh va hi~u
qua. Trong hfru hSt cac mo, thai gian ban huy
cua AH dao d()ng tU 12 gia dSn vai ngay va 6
da la du6i 24 gia. Phan ru AH 16n se hi thoai
hoa b6i enzyme lysosome n()i bao.
Thai gian t6n luu cua AH trong mo my
thu()c vao trQng luQng phan tlr. Qua trinh
viem lam cho vi~c thoai hoa nhanh hon.
Trong cac ung d1,mg y khoa, thai gian t6n
luu cua AH khoang vai tufrn - vii thang.
Sinh tang hQ'P
Cac phan ru duqc t6ng hqp n9i bao. Qua
trinh enzyme phuc t£;tp t£;to ra acid hyaluronic
khong n~m ben trong ts bao va n~m trong
mang tS bao. Hai don vi saccharide ca ban
duqc them vao chu6i acid hyaluronic trong
tS bao va ban than acid duqc phong thich trvc
tiSp trong m£;tng lu6i ngo£;ti bao. Rfrt nhi~u
lo£;ti tS bao co th~ t6ng hqp acid hyaluronic,
nhu: nguyen bao sqi, tS bao ho£;tt dich, tS bao
n9i mo, ts bao tv do va tS bao t~o xuong.
Chu·c nang
Trong m£;tng lu6i ngo£;ti bao, vai tro cua
AH la cfru true ca ban cua mo va dong vai tro:
T£;to th~ tich
Giup boi tron mo
Anh huang m~t d9 tS bao, kha nang
di d9ng va tang sinh cua ts bao.
Trong mo lien kSt, AH (khoang 1% lien
kSt v&i cac phan ru khac t£;to thanh phan ru
16n hon, proteoglycans) dong vai tro duy tri
d9 ~m, d9 cang va d9 dan h6i. Ngoai ra, AH
con dong vai tro nhu m9t 16p xi mang bao v~
cac phan tlr kh6i bi chfrn d()ng, cling nhu t£;to
moi truemg giup bao v~ ts bao khoi cac chfrn
thuong do cac stress v~t ly. Nhfrng chu6i
phan tlr rfrt dai cling v6i ho£;tt tinh gifr nu6c
cho phep cac polymer acid hyaluronic hinh
thanh du trUe m£;tng lu6i dam bao nhfrng
chuc nang:

Da lieu tham my
T<;to ra du true nang do· m6
M~mg lQC ngan ch~n S\f Ian tnl.n cua vi
khu~n va cac tac nhan nhi€m khufrn
khac vao trong mo.
Chi nhfrng phfm tti· trQng luqng th~p m6i
lQt qua m~mg lu6i nay va Ian truy~n trong
m6, t~t ca cac phan h'r trQng luQng 16n, nhu
vi khufrn hay sieu vi khong qua duqc. Acid
hyaluronic, con c6 vai tro t<;to khoang khong
khi te bao c~n di d()ng, phan chia, bi~t h6a
va lanh vet thuang. Ngoai ra, cac kh6p cling
duqc boi tran bai AH.
TU'ong thich sinh hQc
N 6i chung, cac phan h'r sinh hQC duqc
t6ng hgp rir cac loai khac nhau c6 du trUe h6a
hoc khac nhau, khi m()t ch~t ngo<;ti lai xam
nh~p vao CO" th~ , se CO nhfrng dap ling khac
nhau, nhu dap ling mi€n dich hay lo<;ti thai
mo ghep. Trai nguqc v&i cac phan h'r khac,
AH khong thay d6i du true ~6a hQC khf cac
ngu6n t6ng hgp khac nhau. Tat ca c~c te bao
t6ng hgp AH d~u cho ra cling m()t cau trUe. [61
UNG DUNG TrEM VI DIEM ACID HY-
ALURO~HC TRONG TRE HOA DA
Sl! thay d6i a lap mo lien ket, cling
v6i giam m<;tng Iu6i ngo<;ti bao la nguyen
nhan chinh t<;to ra nep nhan va lam da chay
xe. Nhi~u nghien c1ru da chung minh qua
trinh lao h6a anh huang den ho<;tt tinh cua
cac enzyme lien quan den sinh t6ng hgp,
tai c~u true cua cac thanh ph~n trong m<;mg
lu6i ngo<;ti bao cua lap bi (collagen, ela~­
tin va glycosaminoglycans). Va h~u qua tat
yeu, khong chi lam giam m~t d() n;<;tng lu&i
ngo<;ti bao rna con lam , giam chat luqng,
han nfra khi qua trinh tong hqp tra nen it
hfru hieu lam cho cac phan tlr collagen m6i
duqc hinh thanh d€ bi pha vo· bai collage-
nase va metalloproteinases, nhfrng enzyme
chinh trong S\f thoai h6a ngo<;ti bao.
Ngay nay, vi~c tiem trong da cac ch~t
sinh hQc c6 tac d\illg tai t<;to lap bi giup c~i
thien khong chi s6 luqng rna con ca chat
lu~g. M()t trong nhfrng ho<;tt ch~t duqc su
dl}ng thuemg xuyen nh~t 1~ acid hyaluronic
khong lien ket 11! nhien. Nang d9 AH, thanh
ph~n glycosaminoglycan khong sulfate chu
yeu trong m6 lien ket giam theo thai gia?, lam
giam luqng nu6c va d9 ding da. M(>t dieu thu
vi Ia, vi~c tiem cac phan h'r AH nay khong
chi b6 sung them cho m:;mg lu6i ngo<;ti bao,
cung dp d() ~m sau cho da rna con kich thich
nguyen bao sqi, ho<;tt d()ng nhu m()t receptor
chuyen bi~t (CD44, RHAMM va ICAM-1)
d~ t6ng hqp cac thanh ph~n nang do· m6i [Z]
Tiem vi di~m AH giup kich thich nguyen
bao sQi
Nguyen bao sqi trong lap bi ch!u trach
nhiem san xu~t cac thanh ph~n trong m<;tng
luai ngo<;ti bao, thanh ph~n cua m6 lien ket,
quyet d!nh d() ding cling nhu d~c ti~ cua
da. Chinh vi v~y, cac tht'r nghi~m deu, dl!~
tren nguyen bao sqi vi day la thanh phan te
bao chinh cua da.
Ket qua cho th~y vi~c tiem vi di ~m AH
khong d()c cho nguyen bao SQ"i a cac lieu khac
nhau (0,2 mg/mL va 1 mg/mL) va khong a
thai di~m nao (ca 24 va 48 gia sau). Hon
nfra, vi~c tiem AH con giup tang S\f s6ng con
cua nguyen bao sqi len 15,8% ± 3,9%.
Tiem vi di~m AH giup tang t6ng hQ'P collagen
type I va chuy~n rna elastin qua nguyen bao
sQi
Lap bi chu ySu duqc c~u t<;to bcYi m<;tng
lu6i ngo<;ti bao giau collage,n. C:ollagen lap
bi la thanh ph~n protein thiet yeu cua m<;tng
lu6i ngo<;ti bao va g6p ph~n 16n a da (90%
trQng luqng tho). Trong 5 lo?,i collagen ada,
collagen type I chiem da so khoang 80%,
15% con l<;ti la collagen type III va c6 vai
tro trong qua trinh lanh thuang. Han nfra,
elastin trong m<;tng lu6i ngo<;ti bao giup t<;to

d9 dan h6i. Thanh ph~n chinh cua cac sqi
elastin la phan tlr elastin duqc t~o ra tir phan
tir elastin lien k€t k€ c~n .
Luqng collagen 16p bi quy€t dinh d9
day 16p bi, trong khi luqng elastin chiu trach
nhi~m cho d9 dan h6i cua da.
Ket qua cho th~y tiem vi diSm AH lam
tang S\f biSu hi~n cua RNA thong tin rna h6a
cho collagen type Iva elastin s6m trong 24 gia
v6i li~u 1 mg/mL. Hi~u qua t6i da sau 48 gia
cho ca collagen type I va elastin va di~u nay
cling xay ra ngay v6i li~u th~p 0,2 mg/mL.
Trong cac thi nghi~m cho th~y tiem vi
di~m AH kich thich san xu~t cac thanh ph~n
protein chinh trong m~ng lu6i ngo~i bao
thong qua tac d()ng len nguyen bao sqi. [91
Ky thu~t tiem vi di~m acid hyaluronic
Ky thu~t t~o n6t s~n: tiem t~o thanh cac
sAn nho duang kinh 1-2 mm v6i khoang each
t6i thi~u 1 em va t6i da 4 em. Kim tiem duqc
dua vao 1/3 tren cua da, v6i d9 sau khoang
2-3 mm, m~t vat cua kim n~m 6 phia tren.
Muc d() hf>i phl)c va qua trinh tuy thu()c
vao tung lo~i da, d~c tinh cua khiem khuyet
C~n phl)C hf>i, d() sau cua kim tiem va ky
thu~t tiem. Quy trinh c6 thS duqc l~p l~i
hang tu~n hay hang thang, s6 l~n di~u tri
dao d()ng tu 4-1 0 dqt.
Tac dl)ng ph\1 c6 th~ xay ra bao g6m: do
da, phu, dau, cilng da, ngua, chay mau, dau
t~i vi tri tiem [s, 71.
Hinh 2. Ky thu$t tiem vi diem acid hyaluronic (Nguon:
B~nh vi~n Da lieu)
Tiem vi diem acid hyaluronic
HI~U QUA TIEM VI DIEM ACID HY-
ALURONIC
Tiem vi diSm AH c6 hi~u qua trong
di~u tri tre h6a da, bao g6m cai thi~n d9
Am, d9 dan h6i, d9 s~n sui va d9 sang cua
Ian da. Cac nep nhan cling duqc cai thi~n
ro. Han nfra, tren mftu sinh thi€t da con cho
th~y giam interleukin-1 ~' interleukin-6 va
matrix metalloproteinase-1 (MMP-1) va
tang collagen type I va SQ'i elastin. [6]
Tm&c dieu tr!
Sau 4 dqt dieu tr!
Hinh 3. Hi~u qua cua tiem vi diem AH & vung m;;lt
' .
va co
(Nguon: Pierre-Antoine Deg/esne eta/. Clin Cosmet
lnvestig Oermato/. 2016; 9: 41-53)

Hlnh 5. Gia tang dai bang phan am (khoang thay
doi giCI'a dU'&ng mau vang) trong nh6m dU'Q'C tiem
AH 4 thang.
Hlnh 6. Gia tang dai bang phan am (khoang thay
doi giCI'a dU'&ng mau vang) trong nh6m dU'Q'C tiem
AH 9 thang.
(Nguon: Aurora Tedeschi va cc)ng Sl,f. Aesth Plast Surg. 2015;39:129-133)
KETLU~
Tiem vi di~m acid hyaluronic la m<)t
phuong phap dieu tri tre h6a da c6 hi~u qua,
kh6ng chi giup cai thi~n d9 ~m, d9 dan b6i,
d<) cang cua da rna con gitlp Ian da sang va
deu mau hon. Cac dfr li~u chung Cll" tren hinh
anh Uim sang va sieu am cho thfty hi~u qua
cua tiem vi di~m acid hyaluronic tiSp tl,lc h~o
dai sau khi tiem. Hon nfra, day con la m<)t ky
thu?t an toan v&i it tac dvng ph1,1 khi du9·c
thvc hi~n bai cac bac sl da dugc huftn luy~n.
TAl LI~U THAM KHAO
1.
Nguy~n TrQng Hao va c(>ng Slf. The Efficacy and
Safety of Hyaluronic Acid Microinjection for Skin
Rejuvenation in Vietnam. Open Access Maced J Med
Sci. 2019 Jan 30; 7(2): 234- 236.
2.
Adele Sparavigna, Beatrice Tenconi, Ileana de Ponti.
Antiaging, photoprotective, and brightening activity
in biorevitalization: a new solution for aging skin.
Clinical, cosmetic and investigational Dermatology.
2015;8: 57-65.
3.
Antonella Savoia, Simone Landi, Alfonso Baldi. A
New Minimally Invasive Mesotherapy Technique for
Facial Rejuvenation. Derma to/ Ther (Heide/b). 20 13;
3:83- 93 .

4.
Aurora Tedeschi, Francesco Lacarrubba, Giuseppe
Micali. Mesotherapy with an Intradermal Hyaluronic
Acid Formulation for Skin Rejuvenation: An Intra-
patient, Placebo-Controlled, Long-Tenn Trial Us-
ing High-Frequency Ultrasound. Aesth ?last Surg.
2015;39: 129- 133.
5.
Hen·eros FO, Moraes AM, Velho PE. Mesotherapy: a
bibliographical review. An Bras Dermatol. 20 II Jan-
Feb;86( I }:96-1 0 I.
6.
Marina Romagnoli, Magda Belmontesi. Hyaluron-
ic acid- based fillers: the01y and practice. Clinics in
Dermatology. 2008;26: 123- 159.
7.
Martine Baspeyras, Celine Rouvrais, Laetitia Lie-
gard, et al. Clinical and biomelrological efficacy
of a hyaluronic acid-based mesotherapy product: a
randomised controlled study. Arch Dermatol Res.
2013;305:673- 682.
Tiem vi diem acid hyaluronic
8.
Pierre Andre. New trends in face rejuvenation by hy-
aluronic acid injections. Journal of Cosmetic Derma-
tology. 2008; 7: 251 - 258.
9.
Pierre-Antoine Deglesne, Rodrigo Arroyo, Evgeniya
Ranneva, and Philippe Deprez. In vitro study of RRS
HA injectable mesotherapy/biorevitalization product
on human skin fibroblasts and its clinical utilization.
Clin Cos met Investig Derma to!. 20 16; 9: 41 - 53.
10. Richard D. Price, MG Berry, Harshad A. Navsaria.
Hyaluronic acid: the scientific and clinical evidence.
Journal of Plastic, Reconstructive & Aesthetic Sur-
gery.2007;60: 1110-1119.
11. Ruta Ganceviciene, Aikaterini I. Liakou, Athanasios
Theodoridis, Evgenia Makrantonaki va Christos C.
Zouboulis. Skin anti-aging strategies. Dermato-en-
docrinology. 2012; 4:3,308- 319.

"
~
TIEM VI DIEM BOTULINUM TOXIN
TOM TAT
Vi~c s& dt,mg Botulinum Toxin trong th~m my nt)i khoa da c6 tif kha /au, khi d6 chi dinh
chinh cua Botulinum Toxin Ia dung de x6a cac n~p nhan dt)ng. Botulinum Toxin cho k~t
qua tot va tac dl}ng phi} CO the phi}C hoi dU'(!C do thai gian tac dt)ng CUa thUOC khong keo
dai qua ba d~n sau thang. S& dvng Botulinum Toxin tr& nen thong dvng d~n m&c n6i d~n
Botulinum toxin Ia ta nghi d~n x6a nhan. Tuy nhien, khoang 20 nam tr& lf;Ji day, da b;jt dflu
c6 nhi~u nghien c&u bao cao hi~u qua cua Botulinum toxin trong nhil'ng chi dinh khac nhU'
tang ti~t mo hoi tay chan, giam nh&n hay thu nh6 lo chan long. NhU' v~y, hi~u qua tht,J'C SIJ'
cua Botulinum toxin tren cac cau true ngoai CO' nhU' th~ nao? Cho d~n nay, da c6 kha nhi~u
tac gia chau A tif Han Quoc, Singapore va Trung Quoc da cho ra d&i mt)t phU'ang phap
tiem Botulinum toxin kieu m&i, do chinh Ia tiem Botulinum toxin df;Jng vi diem. PhU'ang
phap nay ra d&i, nhU' mt)t cut)c each m(;Jng trong tham my nt)i khoa, vi vifa phat huy toi
da tac dvng tre h6a da cua Botulinum Toxin, vifa ghi nh~n dU'Q'C nhi~u tac dvng khac cua
Botulinum Toxin nhU' giup lam cang da, giam nh&n, se khit lo chan long. Do do, tiem vi
diem hi~n nay da tr& thanh xu hU'&ng, giup phat huy t6i da tac dvng cua thuoc, giup b~nh
nhan sau tiem trong tt,J' nhien han va giam thieu toi da tai bi~n do tiem sai cau true giai ph au
ho?c tiem qua li~u.
GIOITID~U
Khai ni~m tiem vi di~m duqc nh~c d~n l~n d~u tien viw nam 2001 bai titc gia Wu
(Singapore), mvc dich cua tiem vi di~m Botulinum Toxin la dua thu6c vao trong da, nh~m
tac d(>ng d~n cac c~u true khac ngoai ca cua da nhu tuy~n ba, tuy~n m6 hoi hay 16 chan
long. Day la m(>t phuang phap duqc nghi ra v6i mvc dich hoan toan khac v6i phuang
phap tiem Botulinum Toxin tru6c d6. Ban d~u , phuang phap tiem vi di~m Botulinum
Toxin trong ti~ng anh thu<'mg duqc g<;>i la mesobotox, ten g<;>i nay duqc theo phuang phap
mesotherapy tru6c d6. Tuy nhien, v6i ten g<;>i mesobotox khong mota duqc h~t each ti~n
hanh phuang phap nay, vi chung ta bi~t r~ng tiem vi di~m thu6c vao sau trong da han
dung mesotherapy. Do d6 d~n nay, ten g<;>i mesobotox duqc thay th~ b~ng tiem vi di~m.
Day c6 th~ n6i la m(>t ky thu~t kh6, d6i hoi bac si c~n phai c6 sv t~p luy~n d~ c6 each
nha thu6c dung li~u luqng cho m6i di ~m tiem tren da. Nhu v~y, ky thu~t tiem vi di~m c6
gi khac v6i kY thu~t tiem thong thu6ng? va nhfrng tru6ng hqp nao chung ta nen ap dvng
tiem Vi di~m thay vi tiem nhu thong thu6ng? va danh gia hi~U qua thl,l"C S\f CUa phuang
phap nay nhu th~ nao? D6 la nhfrng th~c m~c rna b~t cl:r bac Sl nao khi b~t tay vao thvc
hi~n tiem vi di~m d~u c6.

Botulinum Toxin Ia gi?
Botulinum Toxin la m9t protein do vi
khu~n Clostridium botulinum t~o ra. N6 la
m9t d9c t6 th~n kinh, c6 kha nang gay ch~t
nguoi Li~u gay ch~t trung binh 6 nguo·i la
1,3 -2,1 ng/kg tiem tinh m~ch ho~c 10-13 ng
khi hit vao.
Phan lo~i:
Botulinum Toxin g6m cac lo~i: A, B, C,
D, E, F, G. M~c dli cac lo~i Botulinum Tox-
in khac nhau tac dt,mg len cac d.u true khac
nhau cua t~ bao, tuy nhien n6 c6 hi~u qua
chung la ngan sv ph6ng thich acetylcholine
6 d~u t~n cung th~n kinh. Hi~n nay, chi c6 A
va B la duqc san xu~t thanh thu6c va trong
th~m my n9i khoa cho d~n nay cling chi su
dvng chu y~u lo~i Botulinum Toxin A [51.
Co· ch~ bic d{)ng cua Botulinum Toxin:
Botulinum Toxin sau khi b~nh nhan b!
tiem vao ho~c u6ng nh~m vao se l~p tuc
khu~ch tan vao mo va g~n k~t khong h6i
phvc vao cac d~u t~n cling th~n kinh ca.
Botulinum Toxin phat huy tac dvng nh6'
vao c~u true g6m 2 chu6i n~ng va nh~, g~n
v6i nhau b6i c~u n6i disulfur. Binh thu6'ng,
ho~t d(>ng d~n truy~n th~n kinh dva tren
protein c6 ten gQi la SNARE. Khi Botuli-
num Toxin vao ca th~, chu6i n~ng cua n6 se
g~n k~t v6i glycoprotein xuyen mang tren
d~u t~n cling th~n kinh. Sau khi nh~p bao,
Botulinum Toxin se tach chu6i nh~ ra khoi
c~u true cua n6 d~n c~t phuc hqp SNARE.
Cac Botulinum Toxin lo~i khac nhau se c~t
m9t phuc hqp khac nhau, ch~ng h~n nhu
BTA se c~t phuc hqp SNAP25, BTB se
c~t VAMP. Khi cac phuc hqp nay b! c~t,
se ngan ca cac tui chua acetylcholine xu~t
bao ra khoi d~u t~n th~n kinh. Sv g~n k~t
cua Botulinum Toxin vao d~u t~n cling
th~n kinh la khong th~ phvc h6i, tuy nhien
Tiem vi diem Botulinum Toxin
sau m9t tho·i gian, ca th~ phvc h6i l~i ho~t
d(>ng th~n kinh nh6' phvc h6i cai SNARE
da m~t, ngoai ra cac d~u t~n cling th~n kinh
m6i cling duqc hinh thanh.
Botulinum Toxin sau khi g~n k~t, se c6
cac tac d(>ng uc ch~ ho~t d(>ng len ca van,
phan X~ th~n kinh Va dau [21.
Thufic ghii Botulinum Toxin:
M~c du c6 thu6c d~ giai Botulinum Toxin,
tuy nhien chi c6 y nghia khi b~nh nhan u6ng
nh~m Botulinum Toxin va Botulinum Toxin
con luu hanh tl,f do trong mau, chu hoan toan
khong tac dvng n~u Botulinum Toxin da g~n
k~t v6i d~u t~n th~n kinh [51.
Cac hQ'P chAt pha tiem Botulinum Toxin:
Botulinum Toxin la m9t hqp ch~t khong
mau, duqc nha san xu~t dvng s~n trong lQ,
do d6 cau hoi dUQ'C d~t ra r~ng nen Slr dl,lng
dung d!ch nao d~ pha tiem rna khong lam
thay d6i ho~t tinh cua thu6c? Hi~n nay, da c6
kha nhi~u dung d!ch duqc su dvng trong pha
tiem Botulinum Toxin, m6i lo~i d~u c6 uu va
nhuqc di~m rieng.
Nu6·c mubi sinh ly:
Day la dung d!ch pha loang duqc su
dt,mg cho nhi~u lo~i thu6c tiem. Nu6c mu6i
sinh ly d~ mua, cling d~ su dvng, khong
tuang tac v6i thu6c va giup Botulinum Toxin
hoan nguyen t6t.
Lidocain:
Ngoai dung d!ch nu6c mu6i sinh ly, m9t
s6 tac gia d~ ngh! su dvng thu6c te Lidocain
d~ pha. Lidocain khong lam thay d6i c~u tru
cua Botulinum Toxin sau khi pha va giup
b~nh nhan giam dau t6t. Do d6, day cling
duqc xem la m9t dung d!ch ly tu6ng cho
pha tiem Botulinum Toxin, nh~t la trong thu
thu~t tiem vi di~m.

Da lieu tht!m my
Nfing d() pha va d() Ian toa cua thu6c:
Cau hoi duqc d~t ra h1 thu6c nen pha
loang bao nhieu? N6ng d() pha c6 him imh
hu6ng d€n d() Ian toa cua thu6c trong rna
khang? Cau tnilai nay duqc tac gia Borod-
ic vi€t trong nghien Clru vS d() Ian toa cua
thu6c Botulinum Toxin my n6ng d(), duqc
bao cao tren t~p chi cua H()i R6i Lo~n v?n
dQng Qu6c t€, nam 1994 [!J.
Nghien cUu duqc ti€n hanh nhu sau:
thu6c duqc tiem vao tho s6ng theo cac n6ng
d() 1 UI/0, 1 m1, 2,5 UI/0, 1 ml, 5 UI/0, 1 ml,
10 UI/0,1 m1 va nh6m chling tiem NaCl
0,9%. Sau 5 tu~n , cac m~u duqc sinh thi€t
nhu()m h6a rna tim b~ng chling cua acetyl-
choline, CaC m~u CO' cling dUQ'C do duang
kinh b6 ca 15 mrn d€n 45 mrn ru diem tiem
thu6c. Diu vSt cua acetycholine duqc danh
gia theo thang diem ru 0-4. K€t qua thu duqc
CUa tac gia cho thiy ffiUC teo CO' va diu ho~t
d()ng cua acetycholine lien quan m?t thi€t
d€n n6ng d() pha. C1,1 the, v6i n6ng d() 1
UI/0, 1 ml, thu6c khang Ian toa ra khoi diem
chich qua 15 mrn, trong khi cac n6ng d() con
l~i, thu6c Ian toa kha xa ra khoi vling chich.
Chinh vi th€ tac gia khuy€n cao, khang nen
pha thu6c n6ng d() qua cao, se khi€n thu6c
Ian ra khoi vling ffi\lC tieu va gay ra cac tac
d\lng ph\1 khang mong mu6n.
Ky thu~t tiem vi di~m Botulinum Toxin
Ky thu?t tiem vi diem 1a kY thu?t tiem
v6i mong mu6n dua m()t luqng thu6c nho
vao nang tren bS m~t da, v&i mong mu6n
tac d(}ng len cac ciu true khac ngoai CO' nhu
tuy€n m6 hoi, tuy€n nhan va 16 chan long to.
Hi~n nay, nguai ta su d\lng ky thu?t
tiem vi diem trong m()t s6 chi dinh nhu:
tiem vi diem diSu tri tang ti€t m6 hoi t~i
ch6, diSu tri da bong nhan ho~c 16 chan
long to. vs CO' ch€ tac d()ng cua Botulinum
Toxin tren cac ciu true nay v~n chua duqc
chU:ng minh, tuy nhien da b~t d~u c6 m()t s6
nghien cuu c6 gia tri danh gia hi~u qua t6t
cua ky thu?t nay.
Tiem vi aiJm Botulinum Toxin aiJu trj tang
tiit mJ hoi
Tang ti€t m6 hoi Ia m()t tinh tr~ng m6
hoi bi ti€t ra qua mU:c gay kh6 chiu cling nhu
can tra sinh ho~t cua b~nh nhan. C6 hai lo~i
tang ti€t m6 hoi: toan than va t~i ch6. DiSu
tri tang ti€t m6 hoi b~ng Botulinum Toxin
thuang dung trong tang ti€t m6 hoi t~i ch6
nhu nach hay ban tay. Hi~n nay, da c6 kha
nhiSu nghien c(ru c6 gia tri chU:ng minh duqc
hi~u qua thlJC SlJ cua phuong phap nay.
Su d\lng Botulinum Toxin trong diSu tri
tang ti€t m6 hoi t~i ch6 l~n d~u duqc dS c?p
d€n la trong nghien ctru cua tnam 1997, dang tren t~p chi Lancet [?J_ Trong
nghien Cll'U nay tac gia bao cao m(}t truang
hqp diSu tri tang ti€t m6 hoi b~ng Botulium
Toxin. Ngay sau d6 vao nam 1998, tren t~p
chi ADD cua Hoa Ky tac gia Shelly bao cao
b6n truang hqp diSu tri thanh cong b~ng
Botulinum Toxin. Nghien cuu nay danh gia
hi~u qua cua Botulinum Toxin trong tho·i
gian ng~n cho d€n 12 thang sau d6. Trong
Ca b6n truang hqp, ghi nh?n SlJ giam ti€t mf>
hoi ro r~t , tuy nhien c6 m()t truang hqp ghi
nh?n tac d\lng ph\1 la di cam ng6n tay cai.
Vi day la kY thu?t tiem v6·i mong mu6n
dua thu6c vao nong trong da, do d6 kY thu?t
thuong ap d\lng theo kieu tiem vi diem. vs
liSu luqng va cy thu?t tiem v~n chua du9·c
th6ng nhit, chung ta c6 the ghi nh?n m()t s6
liSu va each tiem trong cac nghien Clru c6
gia tri nhu trong bang sau [61.

Tiem vi diem Botulinum Toxin
Bang 1. Cac nghien cl.Yu v~ tiem vi diem BTX-A trong di~u tri tang tiet m6 hoi t<;~i cho
Tac gia
Vi tri
Nghien cl.Yu m&:
Glogaur31
Nach
Naver
Nach
Karafilov
Nach
Heckmann
Nach
Naumann
Ban tay, nach
Naumann
Ban tay, nach;
Naver
Ban tay
Solomon
Ban tay
Nghien cl.Yu c6 nh6m chl.Yng:
Schnider
Schnider
Heckmann
Naumann
Dimh gia hi?u qua
- Vung mich:
Ban tay
Nach
Nach
Nach
12
55
24
12
11
20
94
20
11
13
145
320
Cgiam ti~t m6 hoi r6 r~t vling nach sau khi
tiem, li~u thu6c duqc dung thay d6i tU 50 UI
d~n 250 UI. Tuy nhien, su d1,mg Botulinum
Toxin li~u cao, khong cho th~y keo dai duqc
thai gian tac dt.mg cua thu6c rna con gay ra
tac dt,mg phv nhi~u hon, ch~ng h;;tn nhu gay
dau hay tv mau v~t chich [GJ_
- Vung long ban tay:
Hi~u qua cua BTX-A tren vling long ban
tay cung duqc chung minh qua cac nghien
cuu tren. Li~u dung cho vling ban tay thuong
cao hon vling nach (tlr 120-200 UII ban tay).
Hi~u qua tac d(>ng keo dai m 4 d~n 12 thang.
Tac dvng phv cung tuang tv nhu vling nach,
tuy nhien m9t s6 truang hqp ghi nhfm dau
khi tiem nhi~u hon va y~u li~t CO' vling ng6n
tay[6l.
T6ng litlu dieu tri
Thai gian tac d¢ng
50
4-7 thang
32-100
3-14 thang
200
-7-10 thang
250 (D)
3-12 thang
30-50
> 5 thang
50
120-200
3-14 thang
165
4-9 thang
120 (D)
> 3 thang
250 (D)
> 3 thang
100/200 (D)
> 6 thang
50
> 4 thang
Tiem vi iliim diJu tri giiim nhirn va ta chiin
lOng to
- Ca ch~ tac d(>ng:
Ky thu~t nay l~n d~u tien duqc d~ c~p
d~n trong bai bao cao v~ nang da m~t khong
c~n phiu thu~t cua tac gia Wu, Singapore,
nam 2001 [!OJ_ D~n nay da c6 kha nhi~u bao
cao cua cac tac gia khac danh gia hi~u qua
cua phuang phap nay. Ca ch~ tac d(>ng cua
Botulinum Toxin len tuy~n ba cho d~n nay
vin chua duqc chung minh, tuy nhien da c6
m(>t vai nghien ctru v~ m~t m6 hQc chung to
tac d(>ng cua BTX tren din truy~n th~n kinh
t;;ti tuy~n ba nhu nghien Clru cua tac gia Li va
c(>ng S\]'[41. Trong nghien cuu nay, tac gia ti~n
hanh nhu(>m h6a m6 mi~n djch d~ danh gia
muc d(> hi~n di~n cua tht;t th~ cholinergic t;;ti
tuy~n ba tru6'c, n6ng d9 lipid b~ng nhu(>m
Red 0 va duang din truy~n th~n kinh b~ng
Western Blottting. Ngoai ra, tac gia con danh
gia hi~u qua lam sang giam nhan sau khi tiem
BTX cua b~nh nhan. K~t qua thu duqc cho
th~y c6 vai tro cua din truy~n acetycholine
tren ho;;tt d(>ng t6ng hqp lipid t;;ti tuy~n ba, khi
uc ch~ duang din truy~n nay b~ng BTX thi
tren lam sang ghi nh~n b~nh nhan giam nhon
r6 r~t.
19 ~
~' ' )
I

Da lieu tham my
Nghien cll'u danh ghi hi~u qua va H~u luQ·ng tiem Botulinum Toxin:
V~n chua c6 lieu luQTig va kiSu tiem th6ng nh~t cho kY thu~t nay, bang 2 th6ng ke cac
nghien ctru c6 gia tri danh gia hi~u qua cua BTX-A:
Bang 2. Cac nghiE'm ct.Yu danh gia hi$u qua BTX_A trong dieu tri giam nh&n 191
each tiem va lieu
IU'gng
Thai gian
theo doi
Ket qua
Shan,
Hoi ct.fu
20
Kim 30 G, g6c nghien
1 tuan
85% b$nh nhan hai long
2008
75 do, 2 Ul/ 0.1 ml,
1 thang
v&i giam nh&n va Ia chan
vu
chQ> T
long thu nh6
Li, 2013(4)
DB-RCT
10
Tiem mai vi trf each
4 tuan
B$nh nhan hai long v&i
nhau 1 em, 2 Ul/ 0.1 ml
giam nh&n va Ia chan long
thu nh6
Wu,
Tiem vi di~m 0.02 Ul
3-4 thang
B$nh nhan hai long v&i do
2015(1 0)
cho mai di~m tiem,
cang da, giam nh&n va Ia
vung co dung 60 Ul.
chan long thu nh6
N6ng d9 pha loang va lieu tiem cho m6i vi tri duqc gqi y trong bang 3. T~t ca cac each
pha loang duqc t6ng hqp tU cac bao cao, v~n chua c6 sv th6ng nh~t ve n6ng d9 ly tu6ng cho
phuong phap nay[S]
Bang 3. Nang do tiem vi di~m BTX_AI8l
Chi djnh
Dan vj (UI)
Tre h6a da
10
Cang w /i giU>a m$t
20-30
San chac vung co
56
KETLU~N
Tiem vi diSm Botulinum Toxin la
mQt ky thu~t mai, doi hoi S\f luy~n t~p ve
ky nang Him sang cua bac sT. Hi~u qua ru
phuong phap nay da duqc ch(rng minh qua
nhieu nghien c{ru c6 gia tfi. Phuong phap vi
diSm ra dai, giup phat buy t6i da hi~u qua
cua BTX-A varna ra nhieu chQn Iva dieu tri
cho bac sl. HiSu r6 ve C(J ch~ cling nhu hoan
thi~n kY nang thvc hanh tiem vi diSm, giup
cho bac si dieu tri hi~u qua hon cac v~n de
th~m my va nang cao muc d9 hai long cho
b~nh nhan.
N6ng dQ pha loang
So dil!m tiem/ vung
5 Ul/ 0,4ml
20-30
20-30 Ul/ 0,8ml
20-30
20-28 Ul/ 1 ml
100-120
TAl LI~U THAM KHAO
I.
Borodic GE, Ferrante R, Pearce LB, Smith K. Histo-
logic assessment of dose-related diffusion and mus-
cle fiber response after therapeutic botulinum A toxin
injections. Mov Disord. 1994;9(1):31-9.
2.
Dressler D, Adib Saberi F. Botulinum toxin: mecha-
nisms of action. European neurology. 2005;53(1):3-
9.
3.
Glogau RG. Treatment of hyperhidrosis with botuli-
num toxin. Derrnatol Clin. 2004;22(2): 177-85, vii.
4.
Li ZJ, Park SB, Sohn KC, Lee Y, Seo YJ, Kim CD,
et al. Regulation of lipid production by acetylcholine
signalling in human sebaceous glands. J Dennatol
Sci. 2013;72(2):116-22.
5.
Maio Md. Botulinum Toxin in Aesthetic Medicine.

6.
Naumann M. Evidence-based medicine: botulinum
toxin in focal hyperhidrosis. J Neural. 2001 ;248 Sup-
pll:31-3.
7.
Naumann M, Flachenecker P, Brocker EB, Toyka
KV, Reiners K. Botulinum toxin for palmar hyperhi-
drosis. Lancet. 1997;349(904 7):252.
8.
Sharad J. Aesthetic dermatology: cun·ent perspective.
Tiem vi diem Botulinum Toxin
9.
Shuo L, Ting Y, KeLun W, Rui Z, Rui Z, Hang W.
Efficacy and possible mechanisms of botulinum
toxin treatment of oily skin. J Cosmet Dermatol.
2019;18(2):451 -7.
10. Wu WT. Microbotox of the Lower Face and Neck:
Evolution of a Personal Technique and Its Clinical Ef-
fects. Plastic and reconstructive surgery. 2015;136(5
Suppl):92S-l OOS.
21 ~
+
f,

"
~
TIEM VI DIEM ACID TRANEXAMIC
TOM TAT
Acid tranexamic (TXA) Ia m()t thu6c ch6ng tieu SQ'i huy~t. Hi~n nay, co nhit§u nghien
c&u cho th!ly vai fro cua TXA trong dit§u tri cac tinh tr;~ng tang sclc t6 nhU': nam ma, tang
sclc t6 sau viem, tang sclc t6 do anh nclng m~t tr&i... TXA &c ch~ vi~c chuyen plasminogen
thanh plasmin, t& do lam giam ho~t d()ng cua men tyrosynase, giup giam Slf hinh thanh
sclc t6. Cac d~ng s& dt,mg cua TXA trong th~m my gom u6ng, boi va tiem vi diem t~i cho.
Trong do, d~ng boi thU'&ng khong co hi~u qua cao d6i v&i tinh tr~ng nam a l&p bi hay nam
hon hQ'p do TXA khong the xuyen qua dU'Q'C lap thU'Q'ng bi. u6ng TXA de dit§u tri nam ma
elm khoang thai gian /au 3-6 thang, do do nhit§u tac gia e ng~i tac dt,mg phtJ gay huy~t
kh6i khi u6ng TXA keo dai. Hi~n nay, tiem vi diem ngay t~i vung nam ma dU'Q'C xem Ia m()t
phU'ang phap dit§u tri hi~u qua va an toan, it tac dvng phtJ toan than.
GIOITHI~U
TXA (trans-4-aminomethyl cyclohexane carboxylic acid), d~n xu~t cua lysine t6ng hgp,
duQ'c tmg dvng trong y khoa ban d~u 1£1 d~ di~u tri uc che tieu sQ·i huyet.
H
COOH
H
Hlnh 1. Cau true h6a hQc cua acid tranxemic
Tng ch6ng l~i vi¢c tieu SQ'i huyet thong qua tac dvng uc ch€ S\1' chuy~n plasminogen
thanh plasmin, phan ru chiu trach nhi¢m cho vi¢c phan huy fibrin. Fibrin la thanh ph~n ca ban
t~o nen vi¢c hinh thanh cac C\}C mau dong trong qua trinh c~m mau. Tac d(>ng nay thong qua
con duemg uc che lysine tren plasminogen, ru d6 uc che vi¢c tieu SQ'i fibrin giup mau dong d~
dang han.
Nam 1968, TXAduQ'c frng dvng d~u tien trong di~u tri rong kinh r~t hi¢u qua. Tu d6, TXA
dUQ'C Slr d1,1ng trong nhi~U chi dinh khac lien quan den cac tinh tr~ng b~t thu(mg V~ dong mau

nhu: hemophilia, xu~t huy~t du<'mg m~u,
xu~t huy~t tieu h6a, chay mau trong phiu
thu~it tim-ph6i nhfm t<;to, t<;to hinh kh6p ...
Tac d1,mg lam tr~ng da cua TXA duqc
phat hi~n tinh ca khi di~u tri cac b~nh nhan
c6 tinh tr<;tng xu~t huy~t phinh d(>ng m<;tch
du&i mang nh~n. Nam 1979, tac gia Nijor
(Nh~t Ban) lfm dfm tien bao cao v~ lqi ich
cua TXA trong di~u tr! nam rna.
Hi~n nay, ngay cang c6 nhi~u nghien
c(ru v~ vi~c ung dvng TXA trong di~u tri
cac tinh tr<;tng tang s~c t6 nhu: nam ma,
tang s~c t6 sau viern, tang s~c t6 do anh
'
nang m~t trai ...
CO CHE TAC Dl)NG CUA ACID
TRANEXAMIC TRONG DIEU TRJ
NAMMA
Nam rna (melasma, chloasma) la tinh
tr<;tng tang s~c t6 m~c phai, di€n bi~n dftn
dftn, bi~u hi~n v&i cac dat mau nau den c6
nhi~u muc d(> d~m nh<;tt khac nhau, thucmg
d6i xung, xu~t hi~n tren cac vung da ti~p
xuc nhi~u v&i anh n~ng m~t tro·i nhu m~t
va co ...
Ca ch~ b~nh sinh cua nam rna vin chua
r5, lien quan d~n vi~c ti~p xuc v&i anh n~ng
m~t trai, bao g6m ca tia qrc tim A, tia C\fC
tim B, anh sang nhin th~y, thai ky, di~u tri
n(>i ti~t, y~u t6 gen va tang sinh m<;tch mau.
Do ca ch~ b~nh sinh phtrc t<;tp nen hi~n
nay vin chua c6 phuang phap di~u tri rieng
le nhanh chong va dut di~m nam rna. TXA
duqc xem la phuang phap m&i c6 nhi~u
tri~n v<;mg trong di~u tri nam ma thong qua
cac CO' ch~:
u c ch~ ho~t d()ng cua plasmin
Khi ti~p XUC v6i tia C\fC tim, cac t~ bao
su·ng tang ho<;tt h6a san xu~t plasminogen.
TXA la m(>t ch~t uc ch~ plasmin tg nhien,
Tiem vi di~m acid Tranexamic
c6 kha nang ngan ch~n vi~c chuy~n d6i plas-
minogen thanh plasmin thong qua vi~c t<;to
ra phtrc hqp dao nguqc v6i plasminogen.
TXA cling ngan can S\f g~n k~t cua
plasminogen v6i cac t~ bao sung, ttr d6 uc
ch~ ho<;tt d(>ng cua plasmin trong cac t~ bao
nay.
Plasmin la m(>t protease gitlp tang cuang
san xu~t acid arachidonic va alpha-melano-
cyte-stimulating trong n(>i bao. Hai ch~t nay
c6 d~c tinh kich thich cac t~ bao s~c t6 t<;to ra
s~c t6. Khi TXA tac d(>ng u·c ch~ ho<;tt d(>ng
cua plasmin se lam giam S\f ph6ng thich acid
arachidonic n(>i bao, din d~n vi~c giam sg
hinh thanh s~c t6 do tia cgc tim.
Ghim san xuAt prostaglandin
Sau khi ti~p xuc v6i tia C\fC tim, cac t~
bao sung ph6ng thich prostaglandin.
Prostaglandin ho<;tt h6a cac du<'mg
truy~n tin hi~u lien quan d~n sv· tang tru6ng,
S\f bi~t h6a va ch~t theo chuang trinh cua cac
t~ bao s~c t6, thong qua sv hinh thanh cac
nhanh trong t~ bao s~c t6 va tac d(>ng d~n
men tyrosinase. Do d6, khi TXA uc ch~ vi~c
san xu~t ra prostaglandin se lam giam ho<;tt
d(>ng cua men tyrosinase, din d~n vi~c giam
sv hinh thanh s~c t6.
Giam Sl}' hinh thanh m~ch mau
Tia C\fC tim kich thich vi~c san xu~t cac
y~u t6 t<;to m<;tch nhu y~u t6 tang truong n(>i mo
m<;tch mau (VEGF), y~u t6 tang tru6ng nguyen
bao sqi CO' ban (bFGF) va interleukin-8.
VEGF tuang tac v6i cac thv th~ cua
chung c6 trong cac t~ bao sung, giai ph6ng
cac ch~t chuy~n h6a acid arachidonic va
plasminogen m cac m<;tch mau tang sinh. Tu
d6, din d~n vi~c hinh thanh s~c t6. TXA tac
d(>ng len cac thanh phftn m<;tch mau cua da
va c6 vai tro trong di~u tri nam rna chu y~u
thong qua CO' ch~ nay.

Da lieu th§m my
Ben qmh d6, y~u t6 tang truemg bFGF
cling tac dong len vi~c hinh th<'mh va tang
sinh cac IDC;J.Ch mau. Ngoai ra, bFGF con tac
dong IDC;lnh len S\I tang sinh va tang truemg
cua cac t~ bao s~c t6. TXA tac dong gian ti~p
d~n vi~c giam san xu~t bFGF thong qua uc
chS hoC;J.t dong cua plasmin. Plasmin c6 vai
tro quan tn;mg trong vi~c giai ph6ng bFGF.
Anh huo·ng d~n S\f' hinh thimh s~c t6
Cac protein lien quan tyrosinase (tyros-
inase-related protein: TRP) g6m TRP-1 va
TRP-2 la nhfrng men quan trQng trong con
du<'mg hinh thanh s~c t6.
Tac dong cua TXA kh6ng chi lam giam
n6ng do tyrosinase rna con giam ca n6ng do
cua TRP-1 va TRP-2.
Tia ClfC tfm
Ph an l.fn g vrem
\
Te bao s.:Vng
Di chuyen
B i ~ h6a
Phatt ri~n
PA
S\I hoC;J.t h6a tin hi~u di~u hoa kinase
ngoC;J.i bao (extracellular regulated kinase:
ERK) gay suy thoai nhan t6 phien rna
(microphthalmia-associated transcription
factor: lVIITF).
MITF la y§u t6 phien rna chinh di~u hoa
cac men lien quan d€n SlJ hinh thanh s~c t6.
TXA kich thich du6ng truy~n tin hi~u ERK
va lam giam n6ng do protein cua MITF. Tu
d6, lam giam SlJ hinh thanh s~c t6 do viem
b~ng each giam bi~u hi~n cua TRP.
Ngoai tac d1,mg ch6ng viem, TXA con
c6 kha nang uc ch~ SlJ hinh thanh s~c t6 nha
vao vi~c di~u chinh phien rna tyrosinase.
HO~It dQng cua
Tyrc:>s ynase
Te bao sac to
/
Thai kj
Thu 6c ng1Ya tt1ai
Plasmin -._._.__.
T~o PA
FGF
rang
tru>c7ng
TB sac to
Ph6ng
thich AA /
X Acid Tranxemic l}·c che qua trinh hinh thanh sac t6
PG E2
LK
Hinh 2. Sa do t6m tat tac d(>ng cua acid tranxemic trong qua trinh hinh thanh sac to
Nguon: Tse TW, J Cosmet Dermatol. 2013 Mar;12(1):57-66

Nhu v~y, thong qua cac CO' che miy da
rna du<'mg cho TXA trc)' th~mh m()t Jo~i thu6c
tiem nang trong dieu tri cac tinh tr~ng tang
site t6, bao g6rn ca nam rna.
Bang 1. CO' che tac dt,mg cua TXA trong nam ma
uc ch~ hoc;~t a9ng cua plasmin
Giam san xu~t prostaglandin
Giam sl)' hinh thanh mc;~ch mau
Anh hu{yng a~n Sl)' hinh thanh sc:ic to
TIEM VI DIEM TXA DIEU TRJ NAM
MA
Cac d~ng su d\lng cua TXA trong thftm
my g6m: u6ng, b6i va tiem vi di~m t~i ch6.
Trong d6, d~ng b6i thucmg kh6ng c6 hi~u
qua cao d6i v6i tinh tr~ng nam a 16p bi hay
nam h6n hqp do TXA kh6ng th~ xuyen qua
dugc 16p thugng bi. U6ng TXA d~ dieu tri
nam rna c~n khoang thai gian lfm 3-6 thang;
Do d6, nhieu tac gia e ng~i tac d\lng ph\1 gay
huyet kh6i khi u6ng TXA k6o dai. Hi~n nay,
tiem vi di~m ngay t~i vling nam rna dugc
xem la m()t phuang phap dieu trj hi~u qua va
an toan, it tac d\lng ph\1 to~m than.
M{)t sa nghien CU'U v~ ky thu~t tiem vi
di~m TXA di~u trj nam rna
Tiem vi di~m trong da hay du6i da la
phuang phap dieu tri dugc su d\lng nhieu
trong y khoa va thftm my. nit ca cac lo~i
thu6c tiem tinh m~ch deu c6 th~ tiem vi
di~m, tru cac dung m6i d~ng d~u hay c6
chu·a ch~t c6n.
Phuong phap dieu tri nay giup d~t duvc
luQ"ng thu6c tuang duang tn,rc tiep t~i nai
c6 b~nh ly, v6i t6ng lieu lugng thu6c vao ca
th~ it hon so v6i dm'mg u6ng, vi v~y rna tac
d\lng phl,l toan than cling se it han.
Nam 2006, tac gia Lee l~n d~u bao cao
hi~u qua cua phuang phap dieu tri tiem vi
di~m TXA tien hanh tren 100 phv nfr bi nam
rna bi va h6n hgp. Vi~c tiem dugc thl,fC hi~n
Tiem vi di~m acid Tranexamic
rn6i tu~n, trong 12 tu~n v6i 0,05 rnl/di~m
( 4rng/ml), each nhau 1 em, lieu t6ng 0,8-
2,4mg. Ket qua nghien ct'ru cho thfty vung
da bj nam bitt d~u sang han tu tu~n thu 3 va
hi~u qua r6 r~t han sau 4 tu~n . 6 tu~n thu
12, c6 51-75% b~nh nhan cai thi~n t6t tinh
tr~ng narn rna. Kh6ng ghi nh~n c6 tac dl,lng
ph\1 xay ra. T~t ca b~nh nhan deu c6 cam
giac bong rat va phu ne nh~ t~i nai tiem,
giam d~n va het sau tiem khoang 10 ph lit
den vai gia.
M~c du a rn()t s6 nai cftm su dl,lng
nhung b6i hydroquinone v~n dugc xem la
tieu chuftn vang trong dieu tri nam rna. Cac
nghien ClrU ve hi~u qua dieu trj thuang SO
sanh v6i phuang phap b6i hydroquinone.
M()t nghien cliu duqc thvc hi~n tren 37 b~nh
nhan narn rna Iran, nua m~t dugc dieu tri
tiem vi di~m TXA, nua rn~t con l~i cho b6i
hydroquinone 2%. Ket qua sau 8 tu~n cho
th~y ben nua m~t tiem vi di~m TXA cai thi~n
tinh tr~ng nam ma cao han ben ntra mi;it b6i
hydroquinone 2%. Tuy nhien, den tu~n thu
20, ket qua ghi nh~n kh6ng c6 sg khac bi~t
ve hi~u qua dieu tri gifra 2 nh6m.
Nam 2018, tac gia She tty tien hanh so
sanh hi~u qua dieu tri gifra tiem vi di€m TXA
va u6ng TXA tren 40 b~nh nhan nam rna An
:D(). Nh6m 1 dugc tiem vi di~m 0,05 rnl TXA
(4mg/ml)/ di~m tiem, cac di~m each nhau
1 em, thgc hi~n rn6i 3 tu~n . Nh6m 2 u6ng
TXA 250 mg, 2 l~n ngay. Ket qua sau 12
tu~n dieu trj, nh6m 1 cho hi~u qua cai thi~n
tinh tr~ng nam rna cao han nh6m 2. Kh6ng
ghi nh~n tac dl,lng phl,l o· ca 2 nh6m.
M()t nghien dm khac cling dugc thvc
hi~n t~i An :D(), tac gia Leelavathy Buda-
makuntla tien hanh so sanh hi~u qua dieu trj
gifra tiern vi di~m TXA va ket hgp Ian kim
vi di~m v6i TXA tren 60 b~nh nhan nam
rna. Nh6m 1 tiem vi di~m TXA tu·ang tl,f cac
nghien cu·u khac. Nh6m 2 dugc ti€n hanh

Ian kim (d9 sau 1,5 em), sau d6 b6i dung
d!ch TXA da dugc pha nhu dung d!ch tiem
vi diem len vling da da thl)'c hi~n Ian kim.
Cac phuang phap di~u tr! dugc ti~n ht:mh 3
l~n, m6i thang/l~n trong 2 thang. Sau 8 tu~n
ghi nh?n k~t qua d~u c6 cai thi~n tinh tn;mg
nam rna a ca 2 nh6m va uu th~ cao han a
nh6m 2.
Nhu v?y, cac nghien ClfU cho th~y phuong
phap tiem vi diem TXA c6 hi~u qua nhanh
trong di~u tr! the nam bi va nam h6n hgp.
Ch~ phfrm TXA tiem tinh m(;lch thu6ng
c6 ham luQng 500mg/5ml. Do d6 khi ti~n
hanh tiem vi diem TXA trong da c~n pha
loang thanh dung d!ch TXA c6 ham lugng
4mg/ml.
U~u tien, chling ta se rut lugng thu6c TXA
la 1 Omg/0, 1 ml, sau d6 ph a loang v&i 2,4ml
nu&c mu6i sinh ly de t(;lo thanh dung d!ch TXA
1 Omg/2,5ml (tuang duang 4mg/ml).
Dung 6ng tiem insulin 1 OOUI, kim tiem
meso dai 4 tmn.
Tiem trong da 6· vling nam ma 0,05-
0,1 ml/diem tiem, cac diem each nhau 1 em,
nen thl)'C hi~n m6i 1-2 tu~n, trong 12 tu~n.
KETLU~N
Hi~u qua cua tiem vi diem TXA di~u
tri nam ma da dugc chung minh trong mot
s6 nghien Cll'U lam sang. Day dugc xem la
phuang phap m&i c6 nhi~u trien vQng vi tinh
an toan, hi~u qua, kh6ng c~n thai gian nghi
duong sau di~u tr!.
TAI LI~u THAM KHAo
I.
George A. Tranexamic acid: An emerging depig-
menting agent. Pigment Int. 20 16;3 :66-71.
2.
Lee JH et al. Localized Intradermal Microinjection
of Tranexamic Acid for Treatment of Melasma in
Asian Patients: A Preliminary Clinical Trial. Derma-
to! Surg. 2006;32:626-631.
3.
Leelavathy Bet al. A Randomised, Open-label, Com-
parative Study of Tranexamic Acid Microinjections
and Tranexamic Acid with Microneedling in Patients
with Melasma. Journal of Cutaneous and Aesthetic
Surgery. 2013 Jul-Sep;6(3):139-143.
4.
Lei Z et al. Tranexamic Acid for Adults with Me-
lasma: A Systematic Review and Meta-Analysis.
BioMed Research International. 2018: l-13.
5.
Nasrin S eta!. Comparing the efficacy of topical hy-
droquinone2% versus intradermal tranexamic acid-
microinjections in treating melasma: a split-facecon-
trolled trial. Journal of Dermatological Treatment.
20 19;29( 4):405-41 0.
6.
Shetty VH et al. Comparative study of localised
intradennalmicroinjectioo of tranexamic acid and
oral tranexamic acid for the treatment of melasma.
Jnt J Res Dermatol. 2018 Aug;4(3):363-367.
Bang 2. T6m tat m()t s6 nghien cliu ve tiem vi diem TXA dieu trj nam ma
Tac gia
Nam
Quoc gia
N
Nghien cU>u
I
K~t qua
Lee JH
2006
Han Ou6c
100
Tiem vi diem TXA 4mg/ml
Cai thii;!n chi s6 MASI
Nasrin S
2019
Iran
37
So sanh
Nh6m tiem vi diem TXA cai thii;!n
-Tiem vi diem TXA
t6t han nh6m b6i hydroquinone
-B6i hydroquinone
Shetty VH
2018
An 8()
40
So sanh
Nh6m tiem vi diem TXA cai thii;!n
-Tiem vi diem TXA
t6t han nh6m u6ng TXA
-U6ng TXA
Leelavathy 2013
An 8()
60
So sanh
Nh6m ian kim + TXA cai thii;!n t6t
B
-Tiem vi diem TXA
han nh6m tiem vi diem TXA
-Lan kim + TXA

A
~
A
,_,
TIEM VI DIEM TIEU M(J
TOM TAT
Mesotherapy (tiem vi di~m) da duqc Slr dvng nhi~u nam nay t~i chau Au va Nam My
trong tai t~o du<'mg net ca th~ va duqc can nh~c Ia di~u tri khong phftu thu~t thay th~ hut
ma. tiem vi di~m phosphatidylcholine va deoxycholate dUQ'C Slr d1,1ng d~ ly giai rna, trong d6
deoxycholic acid la thanh phfm ly giai rna g~n day da duqc FDA Hoa Ky chftp thu~n.
M{)t so thong di~p ve tiem vi diem tieu m(>o:
Tiem vi cJiflm tieu rna Ia m(Jt fi,.Fa chQn khong phlw thu~t hi~u qua af1 tai tc;1o c!U'&ng net
CO' thfl
£Jfl c!c;Jt c!U'c;rc hi~u qua, elm Iva chQn b~nh nhan thich hc;rp va ky thu~t aung
B~nh nhan c~n c!U'c;YC giai thich ve ket qua tranh ky VQng khong thi.)'C te
Ky thu~t nay h&a h(Jn Ia m(Jt cJieu tri khong phau thu~t hi~u qua trong vi~c tai tc;1o
c!U'Crng net CO' thfl.
GIOITHl~:u
Nhu c~u c6 duqc m9t v6c dang ca th~ hoan hao la rna u6c cua rftt nhi~u nguoi Theo t6
chuc Y t~ th~ gi6i (WHO) bao cao beo phi ngay cang tr6 nen ph6 bi~n, chua duqc danh gia
dung muc va chua duqc coi la m9t vftn d~ sue kh6e th~t sv (y dtc qu6c gia da va dang phat
tri~n. D~n nam 2012, tY 1~ beo phi 6 ngm)i tru6ng thanh len d~n 116 tren toan c~u va khi thua
can thi d€ dftn d~n beo phi nhu m9t h~u qua tftt y§u. Chinh vi v~y, nhu c~u di~u tri lo~i b6 rna
du6i da b~ng cac kY thu~t hut ma/tiem tieu rna tai t~o du<'mg net ca th~ ngay cang tang cao.
Hut ma giup lo~i b6 rna du6i da la lo~i phftu thu~t th~m my thu<'mg g~p nhftt. Tuy nhien,
htlt rna Ia m9t phftu thu~t ngo~i khoa, chi phi kha cao va doi hoi phai gay me toan than nen
c6 nguy ca de dQa tinh m~ng. Nhfrng di~u tri kh6ng phftu thu~t thay th~ khac thu<'mg ap dvng
trong thvc hanh lam sang c6: tieu rna b~ng dong l~nh, s6ng sieu am RF, HIFU (high-intensity
focused ultrasound: sieu am h9i t1,l cu<'mg d9 cao) va tiem tieu rna. [6]
Vao cu6i nhfrng nam 1980 t~i Y, bac sT Sergio Maggiori b~t d~u su dvng phosphatidyl-
choline t~m nhu~n vao thuang t6n ban vang va d~t k~t qua nhu mong mu6n. 6ng da trinh
bay phuang phap nay trong H9i nghi v~ tiem vi di~m toan c~u l~n thu 5 t~i Paris, 1988. D~n
nam 1995, bac sT da 1i€u ngm)i Brazil Patricia Rittes di~u tri bQng m~t du6i cua chinh co fry
b~ng each tiem phosphatidylcholine du6i m~t. Nam 2003, "M~ng lu6i cac chuyen gia trong
27 M ~
~
Dif!!!j
{

llnh VlJC tieu rna" duqc thanh l~p t;:ti Due bai
Ulrich Bunzek va Dirk Brandl va chinh thuc
biit d~u nhfrng nghien cuu sau han cua chau
Au v~ n~n tang khoa hQc cua kY thu~t th~m
my nay.
G~n day vi~c FDA Hoa Ky chftp thu~n
deoxycholate (DC) trong chi d!nh di~u tr!
tiem tieu rna khi~n cho ky thu~t nay tra
th:?mh m(>t trong nhfrng thu thu~t chinh y~u
dS tai t;:to du6ng net ca thS. [61
cAc HO~ T CHAT TIEU MO
Phosphatidylcholine
Phosphatidylcholine (PPC) Ia phos-
pholipid quan trQng nhftt va thi~t y~u nhftt
trong ca thS nguai. N6 t;:to di~u ki~n thu~n
lqi dS nhu tuang hoa rna thanh nhfrng ph~n
tlr nh6 nhftt trong cac h;:tt vi c~u , cho phep
n6 duqc hftp thu va v~n chuySn rna. Sau
khi tiem du6-i da, phosphatidylcholine vao
trong m6 mo·, t~ bao rna bi n6 va phospha-
tidylcholine gia tang sv bai ti~t lipoprotein
giau triaglycerol. [IJ
PPC don d(>c thi rftt nhm va vi v~y
khong thich hqp dS tiem [21. Chinh vi v~y,
trong cac cong thuc tiem tren thi tru6ng PPC
phai duqc pha v6-i cac tac nhan khac (vd nhu
mu6i m~t natri deoxycholate) dS gia tang
kha nang hoa tan trong nu6-c tru6-c khi tiem.
Day la m(>t cong thuc an toan, khong ph~u
thu~t dS tieu rna. [?]
Deoxycholic acid
Deoxycholic acid la thanh ph~n cua
acid m~t , d6ng vai tr6 then ch6t trong SlJ nhfi
tuong h6a va tieu h6a rna a ru(>t. Rotunda
va c(>ng SlJ cht'rng minh ring deoxycholic
acid ruben ngoai v~ m~t v~t ly pha va mang
t~ bao rna lam ch~t t~ bao va nhfrng m6 it
protein nhu mo· thi nh;:ty cam v6-i hi~u ung
ly giai t~ bao cua deoxycholic acid han la
nhfrng m6 giau protein nhu da va CO'. Hi~u
.'\A 28
1~ '1;
qua lam sang va d(> an toan cua deoxycholic
acid da duqc chung minh qua nhi ~u nghien
cuu.
Tiem deoxycholic acid (Kybella t;:ti My)
da duqc chftp thu~n nam 2015 la nh6m thu6c
tiem d~u tien trong cai thi~n tinh tr;:tng nQng
dm (di~u tri rna du6i cim). [ !]
Nhfrng ho~t ch§t khac
M(>t s6 chftt kich thich tieu mo· k~t hqp
nhu: melilotus, aminophylline, yohimbine va
isoproterenol giup t;:to ra hi~u qua tieu rna t6t
han so v6i vi~c st'r d1,1I1g don d(>c. C~n luu y
ring lidocaine va cac thu6c te t;:ti ch6 uc ch~
hi~n tuQng ly giai mo·. Chinh vi v~y, nhfing
thu6c te t;:ti ch6 nhu lidocaine va d~n xu.it cua
n6 khong nen Slr d1,1Ilg trong cong thuc k~t
hQp vi c6 thS lam giam hi~u qua. [3l
M(>t vai nghien Clru da cho thfty hi~u qua
cua phosphatidylcholine (PPC), DC cling
nhu k~t hqp v6i cac ho;:tt chftt khac nhu:
L-camitine, vitamin E, collagenase, hyalu-
ronidase. Tftt ca d~u chung minh hi~u qua
tren d6i tuQng nguo·i da triing. Cac tac gia
cfing Slr d\mg cong thuc cocktail PPC va DC
kS ru nam 2004 va cho th.iy hi~u qua tuong
duong 6· nguo·i AnD(> va Dong NamA. [6]
NONG DQ ci.rA cAc c6NG THU'c
Hi~n nay, c6 nhi~u cong thuc k~t hqp
ca deoxycholic acid va phosphatidylcho-
line da duqc tht'r nghi~m. M(>t vai ph6i hqp
chu~n nhu:
Lipostabil chua phosphatidylcholine
(50 mg/mL) cling v6i deoxycholic acid,
natri hydroxide, natri chloride, a-to-
copherol, benzyl alcohol va ethanol.
-
Ky bella chua deoxycholic acid ( 10
mg/mL).
Geolysis chua deoxycholic acid (1 0
mg/mL).

CO CHE HO~T D<)NG
CO' ch~ ho~t d{>ng cua phosphatidylcholine
Y~u t6 ho(;li tU bu6u alpha (TNFa), m<)t
cytokine duqc ti~t ra ru t~ bao rna tru6ng
thanh va di;ii th\l'c bao, la m<)t y~u t6 diSu hoa
chuy~n h6a dm':mg va rna quan trQng. TNF a
la cytokine chinh lien quan d~n ly giai rna
thong qua hi~n tuqng viem trong mo rna, c6
th~ gay tra ch~t t~ bi10 theo chuang trinh. Han
nfra, TNF a con gay ch~t t~ bao theo chuang
trinh ruy theo thai gian va li~u luQng su dt,mg.
Qua cac th\fc nghi~m cho th~y, PPC
tiem khong chi kich thich tieu rna t(;li ch6,
ch~t t~ bao theo chuang trinh, hi~u qua giam
can, rna con g6p phfm trinh di~n RNA thong
tin TNFa va tftm nhu~n di;ii th1,rc bao. Han
nfra, PPC con trc ch~ tan t(;lo rna m6i va uc
ch~ trinh di~n RNA thong tin cua adipokine
(nhu adiponectin va leptin), gitlp lam giam
kich thu6c t~ bao rna. Nhu v~y, cac tac gia
nh~n djnh PPC c6 hi~u qua tieu rna va ch~t
t~ bao rna theo chuang trinh thong qua con
duang ph\1 thu<)c TNF a. [?J
PPC
Tiem vi diem tieu m&
T~ bao rna
Ch ~ t tb theo
chii'O'Ilg trinh
Hinh 1. Sa do cho thay ca che hi~u qua cua phos-
phatidylcholine (PPC) trong ly giai m& va chet te bao
theo chU'ang trinh
(Nguon: Tae
Woo Jung.
Pharmacology 2018;
101:111-119)
CO' ch~ ho~t d{>ng cua deoxycholic acid
Sau khi tiem dung dich tieu rna, thanh t~
bao rna bi pha huy, d~n d~n dong thac cac t~
bao viem ho(;lt tU va giam kich thu6c t~ bao
rna. Dong thac viem con thu hut S\f di cu va
kich thich nguyen bao sqi, hi~u qua tan t(;lo
collagen. [I J
+ 1
+2
+5
+ 1
+3
+ 4
Hi~u qua tf\I'C ri~p len re bao mo
T~ bao mcr
khoe m~
ngay
ngay
ngay
ruan
tuan
man
E>ap 11ng m6 r<)i cho
T .im nhu~ d~i th\1C baa,
th\l'C baa '"" thu bur
Hinh 2. Cache ho~t d(lng cua deoxycholic acid.
(Nguon: Abhay Talathi, Prajakta Ta/athi. Journal of Cutaneous and Aesthetic Surgery. 2018 April-June; 11 (2))
29 ~

Da lieu tham my
CHIDJNH
M& vimg duiri cdm: bi~u hi~n Him sang
la ph~n nho ra a duai ham du6i, muc de)
trung binh d~n nZing, con dugc gQi la cim
doi, nQng cim. Cho d~n nay, vi~c diSu tri
tiem tan rna dugc chftp thu~n bai FDA Hoa
Ky chi trong diSu tri tieu rna V1lng duai cim.
Nhiing khbi mo· khac a mijt va c6: nhu
vling rna, dm va ham la chua dugc chftp
thu~n . K~t qua cua nhung chi d!nh nay rftt
khac nhau va kY thu~t chua dugc chufm h6a
nhu tiem vling du6i cim.
MC)t vai truemg hgp tiem tieu mo· trong
khfJi U rna va tuy~n vU a nam giai cung dUQ'C
ba0 CaO. [ I)
Nhting truemg hgp ly tu&ng d~ tiem tieu
rna la c6 kh6i lugng rna du thl'ra nh6 ( du6i
500 mL). [6)
CHONG CHi DJNH
Ch6ng chi djnh tuy~t d6i: tu6i < 18, mang
thai, cho con bu, b~nh nhan dang su dvng
thu6c ch6ng dong nhu coumadin hay heparin,
dang b~nh nZing hay nhi~m trimg ho<;tt tinh,
tiSn su di ung vai cac san ph~m ru d~u nanh
hay bftt cu thanh ph~n nao trong dung d!ch
~
30 •
tiem, dai thao duemg phv thu()c insulin chua
ki~m soat dugc hay h~ tu~n hoan bj suy y~u ,
beo phi toan than nghiem tn;nig, tiSn su c6
phan ung d1 ung dang k~ vai diSu trL h9i
cbung SQ' kim tiem va nhung b~nh nhan suy
giam mi~n d!ch do ghep t<;tng, nhfrng nguai
dang h6a trt.
Ch6ng chi djnh trrong d6i: mong mu6n
khong thgc t~ , b~nh ly m<;tch mau nh6 hay
thi~u mau nuoi d~n ph~n xa cua chi, b~nh ly
tl)' mi§n nhu xa cl:rng bi, h()i chl:rng Sjoren,
lupus va cac b~nh tl)' mi§n, dai thao duemg
type 2, b~nh tim hay tang huy~t ap kh6ng
6n dinh, b~nh nhan HIV (mZic du nhfrng
buau HIV dap l:rng v&i tiem tieu mo'), b~nh
nhan dang diSu tri aspirin hay khang viem
non-steroid, b~nh nhan dang su dvng liSu
cao corticosteroid, b~nh nhan suy giam chuc
nang gan th~n , b~nh ly cta t<;ti vling diSu trt
va b~nh nhan khong th~ tuan theo ch~ de) an
u6ng va t~p th~ dvc dsu dZin. [3)
HANH GIA BlJ:NH NHAN
Danh gia b~nh nhan bing each quan sat
d9 d~y cua vling du6i dm khi nhin tU tru6c
va theo mZit phing Frankfort. 89 16i dugc
quan sat va phan de) d~ quy~t dinh chi~n luge
diSu trt va dZit mvc tieu diSu tri phu hgp.

Tiem vi diem tieu m6'
Bang 1. Thang diem danh gia cam d6i.
(Ngu6n: Abhay Talathi, Prajakta Talathi. Journal of Cutaneous and Aesthetic Surgery. 2018 April-June; 11 (2))
Khong co
mO'duOi
dm
CHUAN BJVA DANHDAU
Di~u trj mO' vimg du6i c~m
Nh~
MO' dtr6i
dmnh~
Ma 6 vling dim d6i n~m ngay tru&c dai
co c6. Vi th~, tru&c khi dfmh dfm vi tri tiem,
cfm yeu C~U b~nh nhfm CO CO' cfJ de CO the SO
thfry kh6i rna (CO CO' cfJ b~ng each d~n b~nh
nhan h~ ham du&i va n6i Ian "Y").
Kh6i rna vling du&i c~m duqc danh diu
b~ng each xac dinh ranh du&i c~m 6 phia
tru&c, xuong m6ng 6 phia sau va ba hai ben
duqc keo dai tir dinh c~m-m6i xu6ng. Sau
khi xac djnh duqc kh6i rna c~n tiem, danh
dfru cac diem tiem each nhau 1 em. (hinh 3).
M(>t diem m6c giai phiu quan tn;mg
khac c~n duqc luu y la ba duai xuong ham
du&i v&i g6c ham du&i (m6c xuong n~m
truac CO' dn, vj tri cua th~n kinh ham duai).
Th~n kinh ham du&i n~m each ba du&i
xuong ham du&i 1-4 em va g~n d~u g~n cua
g6c ham.
Trung binh
N~ng
R~t n~ng
MO' dtr6i
MO' dtr6i
ll9 IAi du6i
dm thiy
dm thiy
dm nho ra
ro
dt ro
nhieu
Hinh 3. Danh dau vi trf can tiem
(Ngu6n: Abhay Talathi, Prajakta Talathi. Journal of Cu-
taneous and Aesthetic Surgery. 2018 April-June; 11 (2))
D6i v6i nhfi·ng vimg khac
Vi tri tiem duqc danh dfru, nh~m dam
bao du khoang kh6ng va it trimg l~p nhfrt de
t~o SlJ m~m m~i v&i vling da lan c~n.
M6i diem tiem each nhau 1-2 cm.[6J

Da lieu tham my
.,
Hinh 4. Danh d§u nhfYng vj trf dn tiem
(Nguon: Mohan K. Thomas. Journal of Cutaneous and Aesthetic Surgery. 2018 October-December; 11 (4))
KY THU~T TIEM
Ky thu~t tiem vi di~m tieu rna khong
gi6ng nhu tiem vi di~m khac. Tiem vi di~m
la tiem trong da, trong khi tiem tieu rna thu6c
se di d~n l&p mo du6i da. K y thu~t veo da
giup phan ph6i thu6c xu6ng d~n m~t phiing
du6i da va tranh tiem vao trong ca gay dau.
Lieu luqng tiem 6 m~t it han khoang
50% so v6i nhfrng vi tri khac tren ca th~
va m6i di~m tiem khong qua 0,3 ml. T6ng
lieu t6i da cho m<)t l~n la 5g. 89 sau tiem la
10mm 6 than minh va 5mm 6 m~t. [61
Rieng d6i v6i rna vting du6i c~m: De-
oxycholic acid duqc tiem vao trong ma
du6i dm v6i kim tiem 1 mL, d~u kim nh6
(thu<'mg dling kim 30G va 13 mm).
J{ 32
t
~
Nhfrng bu6c thvc hi~n:
1. Sau khi tham vfm, Icy d6ng thu~n va
chvp anh, danh dftu vi tri tiem va giai
thich cho b~nh nhan.
2. Luon chu yvftn de vo khu~n trong khi
thgc hi~n. Theo y ki~n m<)t s6 tac gia,
vi~c thoa te t?i ch6 khong c6 vai tro
trong vi~c giam cam giac kh6 chiu
khi tiem do rna n~m 6 sau, tuy nhien
v6i nhfrng b~nh nhan nh?y cam thi
v~n c6 th~ thoa te.
3. Thu<'mg su dl,lllg 3-5 mL deoxycho-
lic acid cho m6i dqt dieu tri, chia lam
nhieu di~m tiem, m6i di~m khoang
0,2-0,3 mL. T6ng c<)ng 30-50 mg de-
oxycholic acid cho m<)t l§n dieu tri.
4. T6t nhftt nen veo vling rna lend~ dam
bao dung m~t phiing dn tiem. D9 sau
kim n~m gifra 6 - 10 mm ( d9 sau cua
l&p rna).
5. C~n 3-5 dat dieu tri each nhau 4 tu§n
.
.
'
khoang each nay c6 th~ tang len 8
tu§n n~u mu6n giam s6 l§n dieu tri.
6. Khang sinh thoa t?i ch6 sau khi tiem.
7. B~nh nhan thuong cam thfty kh6 chiu
va dau sau khi tiem, keo dai 2 ngay
d~n 2 tu§n, d6ng thai mo· cling giam
d§n. r1l
CHAM SOC SAU DIEU TRJ
B~nh nhan c6 th~ phu nh~, kh6 chiu va dau
sau khi tiem la chi di~m cua tinh tr:;mg viem
trong thai gian 2 ngay - 2 tu§n sau khi tiem.
C6 th~ chuarn l?nh giup giam kh6 chiu,
khang viem u6ng rftt it khi su dvng.
B ~nh nhan khong mat xa vting dieu tri
trong vong 48 gia.

Thong thuong, ket qua duqc danh gia
sau 4 tuin va len ke ho~ch cho dqt di~u trj
tiep theo.
KET QUA LAM sANG
1. Hiu bet b~nh nhfm di~u tri tiem tieu
rna giam tinh tr~ng dm d6i d~u cam
thfty hai long v6i ket qua d~t duqc.
2. Theo m9t s6 bao cao v~ ket qua di~u
trj a nhfrng vting khac tren CO" th~ cling
cho thfty c6 hi~u qua nhu: vling b\mg
tren giam 3,7 em, b\mg du6i giam 3,9
em, dui giam 1,9 em va canh tay giam
1,6 em.
3. Vi ly do an toan, vi~c tiem ma a vling
mi m~t du6i bi lo~i khoi cac chi dinh
tieu rna cua M~ng lucri cac chuyen
gia trong llnh vvc tieu ma va chi
duqc th\fc hi~n bai nha Him sang c6
kha nang xu tri khi c6 chay mau h~u
nhan ciu.
Hlnh 5. (A) Hinh anh trLI'&c dieu tri thay r6 khoi ma
dU'&i cam (cam d6i). (B) Hinh anh sau dieu tri giam
r6 r$t khoi ma dU'ai cam sau 4 dQ't tiem tieu ma.
Tiem vi diem tieu ma
Hlnh 6. (A) Hinh anh trU'&c dieu tri v&i tich t1,1 ma dU'
thCYa quanh khu Vl!C ao ngi,J'c r6. (B) Hinh anh sau
dieu tri giam ma ro sau 6 dQ't dieu tri tiem tieu ma.
(Ngu6n: Mohan K. Thomas. Journal of Cutaneous
and Aesthetic Surgery. 2018 October-December;
11(4))
BIEN CHUNG
Kh6 chiu, dau va phu n~: thuang g~p
nhftt va giam din theo tho"i gian. Phu n~
va dau sau khi tiem deoxycholic acid
c6 th~ kt~o dai 10-14 ngay, trong khi
kh6 chiu sau khi tiem c6ng thuc ph6i
hqp deoxycholic acid va phosphatidyl-
choline c6 th~ len den hang tuin.
Bim tim/xuftt huyet: do t6n thuong
m~ch mau, t~i ch6, thuang mftt sau
vai ngay.
T6n thuong thin kinh ham du6i: do
tiem qua nhi~u deoxycholic acid gin
v6i thin kinh. Tren Him sang se gay ra
cuo·i bftt dfJi xung. Phong tranh b~ng
each tiem dung ky thu~t.
Loet da: do tiem n6ng.
Kh6 nu6t: hiem khi xay ra. [IJ
33 ~
~s

Ngoai ra con c6: tang s~c t6 thoang
qua, phan ling di ling, tac d1,1ng ph\1
toan than hi~m g~p nhu: non 6i, tieu
chay, dau b\lllg, r6i lo~m kinh nguy~t
va ng~t do tiem li~u cao.
KETLU~
M~c du hut rna v~n la tieu chu~n vang
trong di~u tri giam rna du&i da, tiem vi di€rn
tieu rna cling c6 nhling uu di€m rieng nhu
thai gian nghi duang ng~n , it xam l~n va
di~u quan trQng la tam ly kh6ng phai ph~u
thu~t giup b~nh nhan cam th~y thoai mai
hon. Phosphatidylcholine va deoxycholic
acid hi~u qua trong giam rna tich 1\1 khu trli.
Hi~u qua d~t duqc t6i uu sau 3 dqt di ~u tri.
D~c bi~t, d6i v&i rna vting du&i c~m , tiem
tieu rna ClJC ky hi~u qua va an toan. D€ d~t
duqc hi~u qua, ben c~nh vi~c chQn lva b~nh
nhan phu hqp, bac si d.n phai duqc hu~n
luy~n va c6 kinh nghi~rn thvc hi~n thu thu~t
la di~u d.n thi~t. Tiem vi di€m tieu rna la
m(>t bi~n phap h6 trq hi~u qua nhung chua
th€ thay th~ duqc ph~u thu~t hut ma.
TAl LI~U THAM KHAO
I.
Abhay Talathi, Prajakta Talathi. Fat Busters: Lipoly-
sis for Face and Neck. Journal of Cutaneous and Aes-
thetic Surgery. 20 18 April-June; 11 (2).
2.
Alan Matarasso, Tracy M. Pfeifer. Mesotherapy and
Injection Lipolysis. Clin Plastic Surg. 2009;36: 181-
192.
3.
El Kamshoushy A, Abel Maksoud R, and El Mahdy
N. Evaluation of the Efficacy of Injection Lipolysis
using Phosphatidylcholine/Deoxycholate Versus De-
oxycholate Alone in Treatment of Localized Fat De-
posits. J Clin. Exp Dermatol Res. 20 12; 3:146.
4.
Jorg Faulhaber, Matthias Sandhofer, Christel Weiss,
et al. Effective noninvasive body contouring by using
a combination of cryo lipolysis, injection lipolysis,
and shock waves. J Cos met Dermatol. 20 19; 1- 6.
5.
Johnson C. Lee, Mark A. Daniels, Malcolm Z. Roth.
Mesotherapy, Microneedling, and Chemical Peels.
Clin. Plastic Surg. 20 16;43: 583-595.
6.
Mohan K. Thomas, James A. D' Silva, Ateesh J.
Borole. Injection Lipolysis: A Systematic Review of
Literature and Our Experience with a Combination of
Phosphatidylcholine and Deoxycholate over a Period
of 14 Years in 1269 Patients of Indian and South East
Asian Origin. Journal of Cutaneous and Aesthetic
Surgery. 2018 October-December; 11(4).
7.
Tae Woo Jung, Sung Tae Kim, Jun Ho Lee, et al.
Phosphatidylcholine Causes Lipolysis and Apop-
tosis in Adipocytes through the Tumor
ecrosis
Factor Alpha-Dependent Pathway. Pharmacology
2018;101:111 - 11 9.

"
~
TIEM VI DIEM TRONG PRP
TOM TAT
Tiem vi c1iem trong PRP Ia m¢t ky thu~t c1ieu tri it xam Jtm ae c1U'a timg lieu huyet tU'ang
giau titw cau vao thU'ang ton can c1ieu trj thong qua cac not tiem nh6 trong bi ho?c dU'&i
da. PhU'ang phap nay hi~n Ia cong ngh~ c1ieu tri tham my da nhU': s~o, mt,.m, tre h6a da,
x6a nhan, n,mg t6c, Joet m~m tinh ... PhU'ang phap c6 the c1ieu tri c1an c1¢c hay ket hQ'p v&i
cac phU'ang phap truyen thong khac nhU': l(>t da h6a chat, Jan kim hay laser tai t~o, cay m{y
tv than ... N6 mang J~i nhieu IQ'i ich, an toan, it anh hU'ang a en sinh ho~t cua b~nh nhan
nh& tac dt,mg Jam Janh ton thU'ang, tai t~o, tang sinh te bao m&i. Trang c16, PRP tinh khiet
hay L-PRP thU'&ng GU'Q'C s& dt,.mg nhat. Tuy nhien, can c6 them nhieu nghien c&u c1ay c1u
CO tfnh thuyet phi)C nhfJm hieu ro han ve hi~U qua cua phU'ang phap nay.
L<'nMODAU
Nhfrng narn gfin day, d~c bi~t trong llnh VlJC da li~u th~rn my, tiern vi diem (Mesotherapy)
va huy~t tuong giau tieu du (PRP) da duqc giai thi~u la phuong phap di~u tri hi~u qua va
ngay cang ph6 bi~n.
Tiern vi diem la rn()t ky thu~t di~u tri xarn l~n t6i thieu de dua timg li~u nho g6rn h6n hqp
nhi~u thanh phfin vao ca the thong qua cac n6t tiern trong bi hay du&i da. C6 r~t nhi~u ho~t
ch~t duqc su dvng trong ky thu~t nay nhu: chi~t xu~t thvc v~t, ch~t vi luqng d6ng can, duqc
ph~rn, vitamin, ch~t ho~t h6a sinh hQc, huy~t tuong giau tieu d.u ... Hi~n nay, huy~t tuong giau
tieu cfiu li ch~t dUQ'C Slr d1,1ng phf> bi~n trong ky thu~t nay.
Li~u phap tach huy~t tuong giau tieu cfiu (PRP) la phuong phap Slr dvng rnau tv than duqc
chi~t tach de thu huy~t tuong giau tieu cfiu sau d6 tiern vao nhfrng vling cfin di~u tri. Hi~n nay,
PRP dang bung n6 trong nganh th~rn my di~u tri tre h6a da, chfra syo, chfra rvng toe ... N6
c6 the thay th~ hay k~t hqp vai cac phuong phap truy~n th6ng nha PRP khong nhfrng c6 the
lam lanh rna con c6 the tai t~o va kich thich tang tru<'mg cac t~ bao rn&i thay th~ cac t~ bao cu.
Trong khi cha dqi them nhi~u nghien cUu chtmg rninh v~ hi~u qua di~u tri cua tiern vi
diem va PRP thi phuong phap nay v~n dang ti~p tl,lc duqc cac hac Sl th~rn my da ung dvng
ph6 bi~n 6 nhi~u nu&c tren th~ giai, d~c bi~t la 6 Vi~t Narn. T~i B~nh vi~n Da Li~u TP H6 Chi
Minh, phuong phap tiern vi diem PRP la rn()t trong nhfrng phuong phap duqc su dvng rnang
l~i it nhi~u thanh cong va hai long cua b~nh nhan.

Da lieu tham my
TONGQUAN
Tiem vi di~m
Tiem vi di ~m duqc su dt,mg d~u tien
vao nam 1952 b6i Tien si Michel Pistor,
m(>t bac si nguai Phap d~ ki~m soat can dau
va r6i loc;m m:;tch mau. 6ng dil!t ra thu~t ngu
"mesotherapy" va dinh nghia n6 la di~u tri
cua l&p trung bi. Nam 1976, ong mo ta ky
thu~t nay la tiem "kh6i luqng nho vai l~n va
dung vi tri". Ong thanh l~p Hi~p h(>i Tiem
vi di~m Phap vao nam 1964 va nam 1987,
HQc vi~n Y khoa Qu6c gia Phap chinh thuc
cong nh~n tiem vi di ~m la m(>t chuyen
nganh y te [!OJ.
Tiem vi di~m c6 nhi~u ling dt,mg r(>ng
riii di[ic bi~t trong lanh vi~c da li~u th~m my.
Tuy nhien, chi dinh thlJc hanh r(>ng rai hi~n
nay tUy thUQC VaO lo:;ti thuf>c dUQ'C Slr dt,mg
cho m1,1c dich nhu sau:
- Da s~n vo cam, tan rna, t:;to dang co th~
-
Tre h6a da: da sang, san da, giam sic
t6
-
R1,1ng t6c.
Trang khi da s~n YO cam, ling dQng mo·
khu tru va tre h6a da mi[it cho ket qua t6t v6-i
tiem vi di~m thi rl,lng t6c, r:;tn da va di~u tri
sang da cho ket qua muc trung binh trong
khi di~u tri t:;to dang co th~ va nam thi ket
qua con chua ro.
T6ng quan v@ th~ tich h6n hqp tiem, d(>
sau cua kim tiem va s6 li~u trinh c~n thiet
cho tlmg lo:;ti duqc cho du6-i day l2l.
89 sau
S61i$u
trlnh
The
tich
J{ 36
( +
Da s~n v6
cam
1-2mm
11an/tutm*4
tuan
Sau d6 1
lan/2 tuan*3-
41an
5ml/bt,mg,
1 Oml/h6ng-
dui
0,2- 0,6mm
0,5-0,6mm
11an/
1 lan/
tuan*1 o
tuan*4
tuan
tuan
Sau d6
hang thang
2-4 ml toan
5ml toan
m~t
da dau
U(> sau qua da cua kim khong nen vuqt
qua 4mm d~ d:;tt hi~u qua l6l.
PRP (platelet rich plasma)
PRP la huyet tuong giau ti~u c~u tlJ than
chua n6ng d(> t~p trung ti~u c~u cao g~p 4-7
l~n ti~u c~u trong mau binh thuang. Vi~c l~y
mau cua chinh b~nh nhan va Slr d1,1ng cho
nhfrng b~nh ly da khac nhau tren chinh hQ
thuang an toan, giup nhanh lanh vet thuong,
ch6ng viem va th~m my.
PRP chua h:;tt alpha c6 nhi@u yeu t6 tang
truang trong d6 CO cac yeu tf> CO' ban nhu:
yeu t6 tang tru6ng c6 ngu6n g6c ti~u c~u
(PDGF), yeu t6 chuy~n d:;tng beta (TGF~) ,
tang tru6ng bi ~u mo (EGF), tang truong n(>i
mo m:;tch mau (VEGF). Nhung yeu t6 nay
giup lam di@u hoa s\f tang sinh te bao, nh~n
di~n , tan sinh m:;tch. Cac h:;tt d~m di[ic chua
yeu t6 c6 ho:;tt tinh sinh hQc nhu: serotonin,
histamine, dopamine, calcium va adenosine
c6 th~ lam gia tang tinh th~m mang te bao va
di@u hoa phan ung viem.
Thea ly thuyet, c6 4 t~p hCJP con cua
huyet tuong giim ti~u du: PRP tinh khiet
(PRP pure), PRP va b:;tch du (L-PRP), ch~t
n@n fibrin giau ti~u c~u (PRFM), b:;tch du
va PRFM (L-PRFM). Ph~n 16-n cac nghien
cuu thuang ling dl,lilg tren PRP tinh khiet va
L-PRP, trong d6 PRP tinh khiet la d:;tng thuang
duqc su d1,1ng nh~t bao g6rn m(>t 16p buffy coat
cling v6-i m(>t luqng 16-n ti~u du c6 m<)t it b:;tch
du trong d6.
Ho:;tt h6a ti~u c~u nhu thrombin hoi[ic
calcium chlorid duqc su d1,1ng d~ kich ho:;tt
PRP. Khi them C~Cl2, va ly tarn se t:;to ra
d:;tng khong con chat nen fibrin (PRFM), lam
nh~n di~n yeu t6 tang tru6ng va giai ph6ng
chung trong 7 ngay, thuang keo dai lau hun
khi tiern rna hay tang th~ tich mo rn@rn do
sv bai tiet ch~rn hun trong thai gian lau hun.
U6i v6-i t~p hCJP con sau cling g6rn b:;tch c~u
va PRFM (L-PRFM) c6 th~ l~y mau rna

khong them b~t ky ch~t khang dong. Hon
nfra, L-PRFM khong doi hoi b~t ky m<)t ch~t
kich hoc;tt nao.
CHi DJNH - CHONG CHi DJNH
Chi djnh
DiSu tri syo r6
DiSu tri m\}n
Tre h6a da
X6a n~p nhan, lam d~y
Chfra h6i d~u, f\}ng t6c
Chfra v~t loet man tinh, phong, tia xc;t
Ph\lC h6i cac mo b~nh , tang sinh cac
mo khoe mc;tnh.
Chfing chi djnh tuy~t dfii
C~c ~Qi chling m~t chile nang cua
tieu diu
Giam ti~u c~u n~ng < 50 x 109/ dl)
Giam fibrinogen trong mau
Nhi~m trung huy~t
Chfing chi djnh tU'ong dfii
C6 dung NSAID 48 gio· tru6"c khi lam
phftu thu~t
M6"i c6 s6t ho~c cac b~nh nhi~m khac
Ung thu mau
TiSn can nhi~m Pseudomonas, En-
terococcus, Klebsiella
HGB < 10g/dl
Ti~u c~u du6"i 10- 5/!11.
M{)t sfi nguy cO'
-
Nhi~m trung: 1/50.000 ca
Di ling khi gay te tc;ti ch6
B~nh nhan ng~t do th~y mau ho~c do
dau khi tiem
Tiem ra ngoai vi tri diSu tri.
Tiem vi diem trong PRP
QUY TRINH KY THU ~ T
Bmrc chuftn bj
Sau khi tu v~n d~y du, b~nh nhan duQ·c
hu6"ng dftn ky bang cam k~t d6ng y tham gia
diSu tri. Ch\lp hinh theo doi kSt qua diSu tri
tru6"c m6i ti~n trinh va sau khi k~t thuc diSu
tri. Rua m~t, thoa te Lidocain 5% tru6"c m6i
ti~n trinh trong 45-60 phut. C~n theo doi di
ling thu6c te n~u c6.
Cach ti~n himh Ifiy PRP
L~y khoang 30ml mau tinh mc;tch se
cho 3-5ml PRP tliy theo s6 luQTig ti~u c~u
CUa tUng ngueri, thi~t bi Slr d\}ng va cy thu~t
lam. Mau 1~y ra dugc cho vao 6ng c6 them
ch~t khang dong nhu citrate dextrose acid d~
bu6"c d~u dv phong kich hoc;tt ti~u c~u.
Khong lam lc;tnh mau b~t cu· luc nao
tru6"c ho~c trong khi tach bc;tch c~u.
L~n d~u, ly tam mau b~ng each su d\lng
6ng spin mSm hay b<) kit mSm 2000 vong
trong 20 phut, l~y ca huffy coat va 16-p huy~t
tuong dugc thu nh~n lc;ti trong ph~n 6ng cung
khong c6 thu6c khang dong va ph~n mau do
dugc loc;ti ra.
L~n ly tam thu 2 v6"i dung dich trong 6ng
cling khoang 3000 vong d~ c6 d<) t~p trung
ti~u c~u trong 5 phut tc;to ra 16-p huy~t tuong
ngheo ti~u c~u a 2/3 ben tren (PPP) va huy~t
tuong giau ti~u c~u (PRP) a 113 ben du6"i.
Loc;ti bo PPP va nh~n cac ti~u c~u trong
m<)t luQTig nho plasma (2-4 mL) b~ng each
nhy nhang l~c 6ng.
M<)t s6 tac gia kich hoc;tt ti~u c~u v6"i
thrombin ho~c canxi clorua trong khi m<)t
s6 khac lc;ti Slr d\}ng ti~U C~U rna khong dUQ'C
kich hoc;tt tru6"c d6.
C6 r~t nhiSu h~ th6ng PRP dugc thuang
mc;ti h6a, tc;to diSu ki~n thu~n lgi cho vi~c
chu~n bi s~n sang d~ c6 cac dung dich ti~u
c~u ling d\lng diSu tri theo each tai san xu~t.
37 ~
+
f
~

Ky thu~t tiem PRP
PRP thucmg dUQ'C tiem trong da 6· cac
vi tri c~n tiem v6i kim s6 23G sau khi t~o 16
thong khi nh6 d~ tach da.
Sau khi tiem PRP, c6 th~ tiem b6 sung
ppp xen ke vao cac vi tri con tr6ng n~u c~n.
Cham soc sau tiem
Su dvng may di~n di Cryocell v6i nhi~t
d(> l~nh -1 0°C xoa nh~ tren be m~t d§
giam sung, dau (ho~c chuom da)
B~nh nhan n~m nghi 15 phut
Dung giam dau acetaminophen ho~c
khang viem
Kh6ng duQ'c dung NSAID
Danh gia l~i cac chi s6 k~t qua sau 4,
8, 12 tu~n.
Ti~n trinh
Thai gian thv·c hi~n khoang 1g -1g30
C6 th~ ti'ing ho~c giam di~n tich va vi
tri tiem trong cac l~n dieu tri
K~t qua thiy duQ'c sau khoang 3 tu~n
va ti~p 1\IC ti~n tri~n d~n khoang 18
thang sau
D~ k~t qua lau dai, roy tUng truong
hQp, c6 th~ thvc hi~n khoang 3 l~n,
m6i l~n each khoang 4-6 tu~n
Do CO' th~ ti~p 1\IC Hio h6a nen c~n
theo ch~ d(> dieu tri duy tri: khoang 6
thang ho~c 1 nam sau.
M(>T SO NGHlEN CUU
Nghien cU'U cua nh6m tac gia Alessio
Redaelli va c(>ng Sl,l' 23 b~nh nhan keo dai
trong 3 thang nam 2008 da k~t lu~n: tre h6a
da m~t va c6 v6i [mg dvng tiem vi di~m PRP
la m(>t phuang phap tre h6a d~y hua h~n va
d~ thvc hi~n cling nhu dieu tri s~o l' 4l.
T~i h(>i nghi Da li~u H6ng Kong t6 chuc
vao 21-22/06/2014, Giao su Henry HL Chan
da n6i tiem vi di~m PRP la thach thuc m6i
trong linh VlJC th~m my da. Giao su nghien
c(m tren 1 0 b~nh nhan duQ'c su dvng tiem vi
di~m PRP cho dieu tri tham qu~ng m~t va
n~p nhan quanh mi~ng cho thiy m(>t s6 c6
SlJ cai thi~n mau s~c nhung nhilng khia c~nh
khac nhu d(> ~m va n~p nhan thi kh6ng thfry
cai thi~n. Giao su cling bao cao vi~c su dvng
ky thu~t nay trong vi~c tre h6a da v~n con
thi~u nhieu b~ng chung l3l.
Nam 2017, tac gia Juan Ferrando va
c(>ng sg nghien cuu tren 78 b~nh nhan g6m
19 nam va 59 nfr ghi nh~n sau 6 li~u trinh
dieu tri, 71 ,4% f\lng t6c nam gi6i va 73,4%
f\lng t6c nfr gi6i d~t duQ'c k~t qua nhu mong
mu6n trong khi 21 ,4% va 16,3% kh6ng thay
d6i. Chi 7,1% nam va 10,2% nil· thiy k~t qua
t~ han ban d~u l5l.
KETLU~
Tiem vi di~m trong PRP g~n day gay sg
chu y r(>ng kh~p tren th~ gi6i d~c bi~t trong
dieu tri cac b~nh da th~m my do kha nang
cua n6 trong ti~n trinh lanh thuong va t6ng
hgp collagen.
M~c du da c6 nhieu ghi nh~n ve tinh
hi~u qua cua tiem vi di~m PRP trong dieu
tri th~m my da, tuy nhien v~n chua c6 nhieu
nghien cU'U d~y du c6 tinh thuy~t phvc.
TAI Litu THAM KIIAo
I.
Bresnahan, Mike, and Broderick Turner. "Kobe
Bryant undergoes a different kind of knee proce-
dure." Los Angeles Times 30 June 2011. Web. 8 Oct.
2013.
2.
Gillette, Bill. Mesotherapy: Valuable, versatile treat-
ment option. Dermatol Times 2006 Jan; Sect. cosmet-
ic Dermatology. 54-61.

3.
Henry HL Chan. New advances in cosmetic dermato-
logical procedures. Hong Kong J Dermato/. Venere-
al. (20 14) 22, 145-1 52
4.
Jurist, Kenneth A., and Joseph H. Guettler. "Perfor-
mance Orthopedics." Therapeutic Injection of PRP.
N.p., n.d. Web. lO Nov. 2013.
5.
Juan Ferrando, et. A Proposal of an Effective Plate-
let-rich Plasma Protocol for the Treatment of Andro-
genetic Alopecia. lnt J Trichology. 20 17 Oct-Dec;
9(4): 165- 170
6.
Konda D, Thappa DM. Mesotherapy: What is new?.
Indian J Dermatol Venereal Leprol 20 13;79: 127-34
7.
Michael S Leo, BS et al. "Systematic review of the
use of platelet-rich plasma in aesthetic dermatology".
Journal of Cosmetic Dermatology 2015,14,315-323
8.
Mohd Asif MD et al. "Combined autologous plate-
let-rich plasma with microneedling verses micronee-
dlimg with ditilled water in the treatment of atropjic
acne scars:a concunent split-face study"Joumal of
Cosmetic Dermatology 201 6,15,434-443
9.
Niesen, Joan. "FOXSports." Platelet-rich plasma
therapy big with athletes. MSN, 3 July 20 12. Web. 8
Nov. 20 13.
Tiem vi diem trong PRP
I 0. Pistor M. What is mesotherapy? Chir Dent Fr
1976;46:59-60.
11 . "Platelet-Rich Plasma (PRP) Injection-Information
and Instructions fo r Patients." Stanford School of
Medicine: 1-3. Web. 8 Nov. 201 3.
12. "Platelet-Rich Plasma Therapy." Harvard Health
Letter 34. 12 (2009): 6-7. Academic Search Premier.
Web. 6 Oct. 2013.
13. Rachita Dhurat , MS Sukesh,J Cutan Aesthet Surg.
2014 Oct-Dec; 7(4): 189- 197.
14. Redaelli A, Romano D, Marciano A. Odm{adzanie
sk6ry twarzy i szyi za pomocq osocza bogatop{yt-
kowego (PRP): rezultaty kliniczne u 23 pacjent6w.
Dermatol. Estet. 2011 ;13(4):43-44.
15. Ortholnfo. American Academy of Orthopedic Sur-
geons, September 20 11 . Web. Oct. 9 201 3
16. Shetty, Yijay D. "Platelet-Rich Plasma: A 'Feeling'
And 'Hope' Ailing Athletes." British Journal Of
Sports Medicin.
17. Seonguk Min, MD, PhD et al, 201 7, "Combination
of Platelet Rich Plasma in Fractional Carbon Diox-
ide Laser treatment increased clinical efficacy of for
acne scar by enhancement of collagen production and
modulation ofLaser-[nduced inJiammation",Laser in
Surgery and Medicine 50:302-3 1 0(20 18).

A
~
TIEMVIDIEM
/
/
7
x
/
VOl CAC SAN PHAM "COCKTAIL" KHAC
TOM TAT
Da Ia CO' quan the hi~n ro net SIJ' lao h6a, chinh vi the ma ngay nay ngU'&i ta cang muon
tre h6a fan da hay chinh s&a nhCmg van de tren ca the. Trong do, Mesotherapy Ia m(Jt thu
thu?t xam fan toi thieu dlJ'(!c s& dvng r(Jng rai & chau Au va nhieu nai tr{m the giai de dieu
tri da d~ng cac ton thU'O'ng khac nhau. PhU'O'ng phap nay dlJ'(!c biet den tif nam 1952, do
bac sf- tien sf Michel Pistor (Phap) s& dl)ng dau tien cho dieu trj giam dau va cac van de ve
m~ch mau. Hi~n nay, phU'O'ng phap dieu tri khoa hQc nay da pho bien r(Jng rai trfm toan the
giai trong ffnh vvc tham my tri li~u da lieu.
Ngay nay, nhieu ngU'&i tim den cac bac sf vai mong muon tiem cho hQ cac hon hQ'p
cocktail g6m nhieu chat nhU' cac lo~i vitamin, hyaluronic acid, PRP ... vai hy vQng tre hoa
va dinh hinh l~i ca the. HQ tien hanh dieu tri vai mesotheprapy thU'&ng dlJ'(!c dung ky thu?t
tiem vi diem. Moi fan dieu tri b~nh nhan tiep nh?n hang tram mui tiem biing ky thu?t tiem vi
diem. Cac lo~i thuoc dlJ'(!c tiem vao lap bi nong ho~c lap giCPa cua da hay cac mo dich de
d~t dlJ'(!c hi~u qua dieu tri.
GIOITHI~U
Mesotherapy su dvng 1 luqng r~t nh6 thu6c tiem 1f\l'C ti~p vi10 du6i da (16p trung bi)
khong vuQt qua 4m a gftn vling dn di~u tri nh~m mvc dich gay ra cac kich thich sinh hQc d~
d~t mvc tieu di~u tri. Phuong phap thuemg dugc l~p l~i nhi~u lftn, each nhau m()t vai tuftn ruy
theo mong mu6n cua b~nh nhan.
Ngay nay, Mesotherapy cang ngay dugc ua chu()ng vi tinh hi~u qua va an toan. C6 r~t
nhi~u lo~i thu6c dugc su dvng rieng le hay ph6i hgp v6i nhau du6i d~ng cocktail v6i mvc
dich tang hi~u qua di~u tri. v e d{(p cang tv nhien tre trung va r~ng ro cang dugc ua chu()ng, hQ
mu6n dugc nguai khac khen la d{(p tv nhien bon la m()t ve d{(p da qua chinh sua. Do d6, vi~c
di~u tri dn di~n ra ru ru va c6 m()t k~ ho~ch dai h~n, ta se b~t dftu v6i m9t h6n hgp c6 ho~t
tinh tU nh{( d~n trung binh va n~u cftn, ta se tang hay thay d6i cac ho~t ch~t m~nh hon ho~c
tang n6ng d9 cac ch~t hi~n su dvng.
TINH CHAT cAc SAN PHAM COCKTAIL
Hyaluronic acid (HA) la lo~i khong c6 lien k~t cheo ( chuc nang chinh la gifr nu6c ): tich
trfr nu6c g~p 1000 lftn trQng luqng cua minh, ch6ng vi em, khang khuAn, khang n~m, ch6ng

oxi h6a. HA k~t hqp vitamin duy tri sg tang
sinh t~ bao nguyen bao SQ'i cua da
Nhi~u lo(:li vitamin, nguyen t6 vi luQ'llg:
din b~ng ion cho da nhu:
Vitamin A (retinol): Ch6ng oxy h6a,
di~u hoa tang tnrang t~ bao thuQ'ng
bi, ho(:lt d()ng melanocyte. Ki€m
soat ho(:lt d()ng tuy~n bil. Khoi ph\lc
collagen va elastin.
Vitamin C (axit ascorbic): Chflng oxi
h6a, tang t6ng hqp DNA, kich thfch
t6ng hQ'p collagen. U c ch~ t6ng hQ'p
melanin.
Vitamin E (tococpherol): Chflng oxy
h6a, tai t(:lO va sua chu·a thuong t6n
Vitamin nh6m B (1 , 2, 3, 5, 6, 9, 12):
T(:lo coenzyme t(:lo nang luQ'ng cho t~
bao, c~n cho t6ng hQ'p hormone, giup
lo(:li bo cac g6c tv do.
Axit amin, protein thvc v~t: gitlp tai
t(:lo protein.
Dimethylaminoethanol (DMAE): ti~n
than cua phosphatidylcholine, chuy€n
d6i choline thanh acetylcholine (Ach)
din d~n coca, san ch~c ca b~p dung
cho I /3 m~t du6i.
Taurine:
2
aminoethane-sulfonic,
ch6ng oxi h6a, khang vi em, v~n m(:lch.
Kich thich t~ bao keranotin tang t(:lo
collagen, gifr frm. Dung tai t(:lo da lao
h6a.
Hexapeptide 3: ngan ph6ng thich
Ach va do d6 thu gian cac ca va Jam
ph~ng cac n~p nhan dung cho 1/3 m~t
tren
Acetyldecapeptide-3: lam giam va
ngan n~p nhan do tang tai t(:lO cac t~
bao da m6i
Decapeptide-4: chflng lao h6a va lam
lanh v~t thuang
Copper tripeptide-!: gi(tp tang luu
Tiem vi di~m v&i cac san pham "Cocktail" khac
thong mau trong da va phi)C hf>i da
Oligopeptide-24: giam thi€u st:;o tren
da b~ng each hinh thanh t~ bao da
m6i
Tripeptide-6: giil' frm da kho va can
b~ng d() frm t6i uu
N goai ra, nhfrng ho(:lt chftt khac nhu
pentapeptide, L Camitine va cam thao. Cac
chftt peptide la m()t trong cac thanh ph~n
quan trQng cua phuong phap mesotherapy.
Silica hfru ca la m()t polysacarid duQ'c
chi~t xuftt ru· tao. N6 tan trong nu6c,
chftt ch6ng oxy h6a giup tai du true va
cung cfl cac mo k~t hQp, SQ'i collagen
va elastin ngan ngua lao h6a da. Ngoai
ra, n6 con c6 tinh dung n(:lp t6t.
PRP:
chi~t tach cac y~u t6 tang
tru·o·ng tlr ti€u du trong chinh mau
cua nguo·i dUQ'C di~u tri. Tiem trong
da, giup cai thi~n tu~n hoan cho da,
pha va collagen eli tang tai t(:lo colla-
gen m6i nh~m tre h6a da. Dung trong
rl)ng t6c, tre h6a da.
y ~u t6 tang tnrang va t~ bao g6c trong
mesotherapy: Thymosin TB-4, la m()t
y~u tfl tang tru6'ng, dUQ'C tiem vao da
d~u , nh~m mvc dfch tang truang nang
t6c b~ng each cai thi~n luu thong,
kich thich cac t~ bao gflc va ph\IC hf>i
nang long.
T~ bao g6c thu duQ'c ru tliy xuang
hi~n dUQ'C quang cao nhu thanh ph~n
cua huy~t thanh lam tr~ng va giam
n~p nhan nhung hi~u qua dn duQ'c
danh gia them.
Mesobotox: Tiem li~u nho cua botu-
linum toxin vao trong da, giam n~p
nhan va giam ho(:lt d()ng tuy~n ba
nhcm. Botulinum toxin duQ'c pha v6i
nu6'c mu6i sinh ly c6 th€ k~t hQ'p them
v6i thu6c te d€ t(:lo n6ng d9 khac nhau
tuy vling di~u tri.

Da lieu tham my
HON HQP COCKTAIL VA CHi DJNH
Cac ho~t ch~t dugc su d1_1ng dugc phan
thanh hai lo~i:
-
Cac ho~t ch~t chinh (P)
-
Thanh phfrn b6 sung (C)
Cocktail ho?c h6n hQ'P nen chua it nh~t
hai den ba tac nhan c6 ho~t tinh
Cocktail trong chi djnh Mesolift
Axit Hyaluronic (P)
Silorgamine = Silorg + DMAE (P) +
taurinox (C)
Vitamin A (P)
Cocktail trong chi djnh Mesoglow
Ax it Hyaluronic (P)
Silorg (P)
-
Vitamin C (P) + xadenal (C)
Cocktail trong chi djnh Mesolighten
Axit Kojic (P)
-
Axit Azelaic (P) + ho?c tretinoin (C)
ho?c glycolic axit (C)
-
Vitamin C (P)
Cocktail trong chi djnh tan mo· eve b()
-
Phosphatidylcholine (P) va axit De-
oxycholic (P) +/- phuc hgp vitamin
+/-taurine +/- L Camitine +/- alfa axit
lipoic +/- silic hfru ca +/- aminophyl-
line axit amin +/- axit pantothenic
Cocktail trong chi djnh cellulite: dt ca d~u
la tac nhan chinh (P)
L-Camitine
-
Aminophylin
-
Pentoxiphylin
-
DMAE
-
Vitamin C
Procaine
Cocktail trong chi djnh qm da: t~t ca d~u
la tac nhan chinh
Silorgamine = silorg + DMAE ho?c
-
Idebe = idebenone + DMAE ho?c
-
Centella asiatica, fibronectin, protein
thvc v~t
Cocktail trong chi djnh n.mg toe:
Biotin (P) + vitamin t6ng hgp, nguyen
t6 vi l ugng (C)
-
Dexenol (P)
Cocktail trong rvng toe androgenetic
-
Minoxidil (P)
-
Dutasteride (P) + kern, axit azelaic
(C)
-
Biotin (P)
-
Dexenol (P)
KY THU~ TV A DVNG CV TIEN HANH
Phll'ong phap tiem c6 di~n: Kim 270, 300,
320,340
Kim dfru tran, kh6a luer 5 rnL, 10 mL, 20
mL
Vong hay t~m da kim (3,5,7)

Sung Meso
Vu di€m: tiem nhanh, li~u chinh xac, d9
sau phu hqp va b~nh nhfm it dau han. N6 c6
cac ch€ d9 khac nhau nhu lien t\,lc, ch€ d9
d!nh li~u, tiem nhi~u ky thu~t.
Quy trinh va ky thu~t tiem
Sau khi c6 duqc S\f d6ng y v6i b~nh
nhfm, bac sT se lam s~ch da b~nh nbfm t~y
trang, rua m~t , sat trung bing dung d! ch
khong chu·a c6n va gay te t~i ch6.
Sau d6, tiem bing kim hay sung.
M6i l~n di~u tri m~t khoang 10-30 phut.
Kbong c6 cong thuc chu~n h6a cho li~u
phap va cac thanh ph~n khac nhau tUy thuvao chi d!nh.
Cac ky thu~t thucmg duqc su d1,mg:
Tiem thuQ'llg bi: Ky thu~t tiem nang
nh~t (sau < 1mm), ky thu~t khong
Tiem vi diem v&i cac san ph~ m "Cocktail" khac
anh hu6ng d€n 16p mang day cua da
(con gQi la superficial nappage). Kim
30-320, keo nhy kim tren da, ap ll,fC
duong cho pit-tong. Cac duang dan
lu6i khoang each 1 em tren toan b9
khu Vl,fC di~u tri. Dting cai thi~n 16
chan long va mau s~c da. Kbong hay
r~t it chay mau.
Tiem trong bi nang: tiem thu6c vao
vting n6i thuQng bi va bi (dQ sau 0.5-
2 mm) t~o 1 s~n tr~ng nh6 (< 0,1ml/
di€m) hay c6 th€ dting ky thu~t nap-
page cac di€m kim each nhau 2-4mm.
Kim 300 4mm. Chu ySu duqc su
dvng cho cac n€p nhan, [\.lng t6c va
mesobotox.
Tiem trong bi sau: tiem 0,02-0,05 ml
vuong g6c v6i da (sau 2- 4 mm), kim
300 4mm, d~t kim 45 dQ, khoang

each 1-2 em, khong tc;to thc'mh san.
Cai thi~n d<) san ch~c cho da
Tiem trong hc;t bi: Dung kim dai
13mrn, (sau tlr 4-13mm my vi tri),
khoi'mg each 0,5-2cm. Luqng thu6c
c6 th~ > 0,1 mlldi~m . B~nh nhan c6
cam giac dau. Thuemg tiem giam rna.
Trong kY thu~t tiem trong bi ta c6 cac
each tiem sau:
Tiem n6t s~n
Tiem tuy~n tinh dc;tng duong
Tiem b~t cheo (mc;tng lu6i).
CHi DJNH CUA MESOTHERAPY
Mesotherapy dugc su dt,mg r<)ng dh trong
llnh V\fC da liSu thim my. Hi~n nay, cac chi
d!nh thuemg dugc su dt,mg nhi~u nhfrt:
Da s~n v6 cam
Tan rna Cl,lC b<)
Tc;to duemg vi~n ca th~ (khong hi~u
qua nhi~u)
Tre h6a da
Tiem cang bong da
Di~u tri tang s~c t6
Di~u tri fl,lng t6c (fl,lng t6c telogen,
fl,lng t6c androgenetic ).
CHONG CHi DJNH CUA MESOTHERAPY
Di 11ng v6i bfrt cir thanh ph~n nao cua
thu6c
Ti~n su s~o phi dc;ti hay s~o 16i
R6i loc;tn dong mau hay dang Slr dt,mg
thu6c ch6ng dong
Mang thai hay cho con bu.
B~nh tv miSn (Lupus, xa ctrng bi ... )
D<)ng kinh
B~nh ti~u ducmg
B~nh tim n~ng , b~nh th~n , huy~t kh6i
Herpes simplex virus loc;ti trong giai
doc;tn hoc;tt d<)ng
NhiSm khui n trong giai doc;tn hoc;tt
d<)ng
Tinh trc;tng viem da dp tinh
Tu6i < 18 tu6i, dai thao duemg, BMI
> 30
R6i loc;tn nh~n thuc v~ ca th~
C6 mong dgi vuQ't qua tlwc t~.
Cac phac d6 di~u tri dugc dua ra my theo
CO' dja va tinh trc;tng rung tru(mg hgp phu hgp
v6i mong mu6n cua chinh b~nh nhan.
V6i mong mu6n dc;tt hi~u qua tre h6a da,
Chung ta dn Sl,f ll,l'a ChQn chinh xac va Sl,f k~t
hgp cua cac hoc;tt chfrt phu hgp v6i tinh trc;tng
da nguai b~nh. Ki~n thuc v~ tinh chfrt dugc
ly cua nhi~u chfrt c6 hoc;tt tinh la m<)t di~u
c~n thi~t.
Nguai ta thfry ring mesotherapy cho k~t
qua t6t vai da S~n VO cam, tan rna Cl,lC bQ va
tre h6a khuon m~t. Trong khi d6, fl,lng t6c,
rc;tn da va tang s~c t6 cho thfry k~t qua wa
phai va k~t qua kern hon v6i chi d!nh tan mo·
bl,mg, dui, hong d~ tc;to duemg vi~n va di~u
tri sc;tm da.
KETLU~N
Trong nhfrng nam g~n day, li~u phap
mesotherapy va ky thu~t tiem vi di~m cang
ngay cang tra nen ph6 bi~n do it ho~c khong
xam lfrn, khong gay dau dan, tuy nhien chua
c6 bfrt ky cong thuc c1,1 th~ nao quy d!nh v~
hi~u qua va thanh ph~n cua cac loc;ti hfln hgp
dugc su d1,1ng.
Vi~c su d1,1ng cac hfln hgp mang lc;ti hi~u
qua nhi~u han, tuy nhien cling mang lc;ti nguy
CO' dj trng va tuang tac cac thanh ph~n CUa
thu6c v6i nhau, vi th~ dn th~n trQng trong
chi djnh va chQn lt,ra d6i tugng di~u tri cling
nhu hfln hgp di~u trj.