Mesotherapy and Nonsurgical Fat Melting
Tuesday, November 08, 2005
The term "mesotherapy" applies not so much to a procedure with a
particular outcome, but to an injection technique. Similar to
descriptive terminology like "intramuscular injection,"
"subcutaneous tumescent infiltration," and "oral administration,"
the term "mesotherapy" does not address the drugs or products that
are being administered or the reason for administration but merely
the way it is injected.
Developed in France in the 1940s, mesotherapy was the term used
for the injection of drugs into the "mesoderm" in targeted areas to
address conditions such as tinnitus and pain. Other published
medical indications over the decades have included musculoskeletal
disorders and vascular diseases.1-4
Mesotherapy has recently gained widespread media popularity with
promises of weight loss, nonsurgical fat reduction, treatment of
male-pattern alopecia, and wrinkle reduction. It should be noted
that, at this time, mesotherapy has not been subjected to critical
evidence based medical protocols. Moreover, there have, as yet, not
been full comparisons of benefits with detrimental effects, such as
infection. Ultimately, all of these issues must be addressed before
the various forms of mesotherapy may be promoted with any
confidence that they are safe and effective.
The drug "cocktails" administered via mesotherapy are tailored
to the condition being treated. They have included a variety of
prescription medications (both those intended for parenteral use
and those only found in oral formulations), herbs, vitamins,
hormones, beta agonists, cyclic amp inhibitors, or emulsifying
There are 4 distinct administration techniques:
- Duperficial injection (as one would administer Zyderm
- Intradermal injection (as one would administer Zyderm
- Deep dermal (as one would administer
- Subcutaneous (as one would perform fat injection)
The choice of level of injection is tailored to the condition
being treated. These injections are administered either with a
syringe or mechanical delivery gun attached to a small gauge needle
with a serial puncture technique.
The important point to understand is that there are no
standardized formulations or injection techniques, so data
collection on both the efficacy and safety of mesotherapy with
various cocktails is lacking. There is a dearth of any published
papers on mesotherapy for cosmetic indications in the
English-speaking medical literature.
One of the only papers published came out of the bariatric
literature in the 1980s. In this study, isoproterenol was injected
into the thighs of obese women. The injected thigh showed decrease
girth as compared to the thigh that received a placebo injection.
The caveat, though, was that the most statistically significant
reduction was seen in the subjects who had also lost
weight.5 It seems that beta-adrenergic agents like
isoproterenol may stimulate "spot reduction" in situations of
caloric deprivation. Of course, beta-adrenergic agents can affect a
variety of tissues and indeed isoproterenol can be found in the
American Heart Association's algorithm for bradycardia.
Other concerns with the efficacy and safety of various
mesotherapy cocktails are as follows:
- Many drugs in the mesotherapy cocktails are oral or topical
medications/vitamins/herbs "sterilized" for use parenterally. Do
these drugs change after heat sterilization to an inactive or
potentially toxic compound? Are oral drugs even active in their
current forms, or do they need to be ingested and undergo
conjugation by the liver? Do drugs originally intended for topical
use need epidermal enzymes for activation? Are these drugs truly
sterile and what quality control ensures this?
- What is the correct therapeutic dose when drugs are
administered via mesotherapy? When one considers the multiple
studies done to find the safe mg/kg dose of lidocaine used in
tumescent anesthesia, one can appreciate the amount of data
required to assess safety. Some drugs in the mesotherapy cocktails
are lipid soluble, others are not. Which law of pharmacokinetics
applies to which drug? Is safety determined in total dose, or is it
dependent on weight or on total body fat?
- Do these drugs (intended for solo use) interact with each other
and negate or potentiate each other's benefits? Do they combine to
form a unique compound? Is this "new" compound toxic? Do any of the
drugs in the cocktail interact with medications the patient may be
taking on a regular basis?
Complications from mesotherapy that have been described in the
literature include atypical mycobacterial infections,
Koebnerization, irregular contours, urticarial and lichenoid
reactions, and skin atrophy and necrosis.6-10 Physicians
who employ mesotherapy should be cognisant of these and all other
Mesotherapy for Body Contouring
Mesotherapy using a mixture of deoxycholate and
phosphatidylcholine is often termed "lipotherapy".
Phosphatidylcholine induces lipolysis and can lower blood
triglyceride levels when ingested orally. Recent data suggests that
its lipolytic effects when administered via mesotherapy, however,
are from the detergent properties of deoxycholate.11
Because of solubility problems with phosphatidylcholine in a
mesotherapy solution, deoxycholate is always necessary, so the
effects of phosphatidylcholine alone cannot be evaluated.
One small clinical trial has been done to evaluate the efficacy
and safety of phosphatidylcholine in the treatment of localized fat
in the suborbital area over a 9-month period. The study was open
label, and frequently multiple injection sessions were needed.
Edema and erythema lasting up to 3 days was observed in 70% and 90%
of the patients respectively. Although the majority of patients
expressed satisfaction with the results, 50% showed recurrence of
the suborbital fat at 9 months.12
Injectable phosphatidylcholine is not approved by the Food and
Drug Administration (FDA) in the United States for any use, and
there are no FDA-approved injectable agents for body contouring
Recently, an adaptated Neodimium YAG Laser (NdYAG) operating at
a wavelength of 1064 has shown promise as a lipolytic device. It
utilizes a 1mm cannula with a fiberoptic delivery system. Clinical
trials are currently underway in the United States. Previous
reports have shown promise not only in its ability to lyse
adipocytes and thus improve body contours, but also in its apparent
capability to induce tissue contraction in areas of skin
flaccidity. It is not a replacement for conventional tumescent
liposuction, but rather a complement to it.
The shortcomings of this technology are the cost of equipment,
the minimal amount of fat removal per session, and the increased
Mesotherapy is a name given to a method of delivery of various
single drugs and drug cocktails into skin. Information on its
safety and efficacy is at present anecdotal.
Lipotherapy using a mixture of deoxycholate and
phosphatidylcholine shows promise as a nonspecific lipolytic agent,
but it is currently not approved by the FDA. Other technologies,
like lipolytic lasers are on the horizon but in their infancy.
The lack of reliable data where nonsurgical fat removal is
concerned gives rise to ethical issues when performing these
"experimental" procedures. Until proven otherwise,
dermatologist-performed tumescent liposuction is still the safest
fat-removal technique currently available.
It should be noted once again that mesotherapy has not been
proven effective through critical evidence-based medical protocols.
Moreover, there have, as yet, not been full comparisons of benefits
with detrimental effects, such as infection. Ultimately, all of
these issues must be addressed before the various forms of
mesotherapy may be promoted with confidence.
- Menkes CJ, Laoussadi S, Kac-Ohana N, et al. Controlled trial of
injectable diclofenac in mesotherapy for the treatment of
tendinitis. Rev Rhum Mal Osteoartic. 1990
- Guazzetti R, Iotti E, Marinoni E. Mesotherapy with naproxen
sodium in musculoskeletal diseases. Riv Eur Sci Med
Farmacol. 1988 Dec;10(6):539-42.
- Gallo R. Mesotherapy in phlebology. Phlebologie. 1980
- Donini I, De Anna D, Carella G, et al. Mesotherapy in the
treatment of lymphedema: histologic and ultrastructural
observations. Chir Patol Sper. 1982 Feb;30(1):25-34.
- Greenway FL, Bray GA. Regional fat loss from the thigh in obese
women after adrenergic modulation. Clin Ther.
- Lee DP, Chang SE. Subcutaneous nodules showing fat necrosis
owing to mesotherapy. Dermatol Surg. 2005
- Grojean MF, Vaillant L. Lichenoid eruption caused by
mesotherapy. Ann Med Interne. 1995;146(5):365-6.
- Urbani CE. Urticarial reaction to ethylenediamine in
aminophylline following mesotherapy. Contact Dermatitis.
- Friedel J, Piemont Y, Truchetet F, et al. Mesotherapy and
cutaneous mycobacteriosis caused by Mycobacterium fortuitum:
alternative medicine at risk. Ann Dermatol Venereol.
- Rosina P, Chieregato C, Miccolis D, et al. Psoriasis and
side-effects of mesotherapy. Int J Dermatol. 2001
- Rotunda AM, Suzuki H, Moy RL, et al. Detergent effects of
sodium deoxycholate are a major feature of an injectable
phosphatidylcholine formulation used for localized fat dissolution.
Dermatol Surg. 2004 Jul;30(7):1001-8.
- Ablon G, Rotunda AM. Treatment of lower eyelid fat pads using
phosphatidylcholine: clinical trial and review. Dermatol
Surg. 2004 Mar;30(3):422-7.
- Ichikawa K, Miyasaka M, Tanaka R, et al. Histologic evaluation
of the pulsed Nd:YAG laser for laser lipolysis. Lasers Surg
Med. 2005 Jan;36(1):43-6.
- Badin AZ, Moraes LM, Gondek L, et al. Laser lipolysis:
flaccidity under control. Aesthetic Plast Surg. 2002