Mesotherapy: French Connection

Written by Vanessa Ngan, Staff Writer, 2005. Reviewed by Dr Ebtisam Elghblawi, Dermatologist, Tripoli, Libya. Edited by A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Updated in October 2018.

Mesotherapy is a minimally invasive procedure that involves injecting a mixture of vitamins, minerals, amino acids, and medications directly into the mesoderm, the middle layer of the skin. This technique is used to treat a variety of skin conditions, including aging, cellulite, and hair loss.

The practice of mesotherapy was first developed in France in the 1950s by Dr. Michel Pistor. Since then, it has gained popularity around the world as a safe and effective way to rejuvenate the skin and improve its overall appearance.

During a mesotherapy treatment, a series of injections are administered into the targeted area using a very fine needle. The mixture is customized to meet the specific needs of each patient, and the injections are usually given over a series of sessions to achieve the desired results.

Mesotherapy is often used in conjunction with other cosmetic procedures, such as laser therapy or chemical peels, to enhance the overall effects. It is important to consult with a qualified dermatologist or aesthetician before undergoing mesotherapy to ensure that it is the right treatment option for you.

Understanding Mesotherapy

Mesotherapy is a modern technique used for fat elimination, body shaping, and various medical conditions like alopecia, arthritis, and psoriasis. It involves injecting specific substances beneath the skin’s surface to target different issues such as weight loss, cellulite reduction, and skin rejuvenation.

Although well-established in Europe and South America, mesotherapy is relatively new in the United States and New Zealand. The FDA has not approved any medications for this practice, and the American Society of Plastic Surgeons does not endorse it.

The Procedure of Mesotherapy

Mesotherapy consists of injecting mixtures of substances under the skin into the fat tissue. The content of these mixtures varies depending on the formulation prepared by the practitioner and may include plant extracts, vitamins, collagen boosters, and skin hydrators.

Some common substances used in mesotherapy include hyaluronic acid, amino acids, antioxidants, and minerals. These substances are believed to help improve skin tone, reduce cellulite, promote hair growth, and rejuvenate the skin.

The procedure of mesotherapy typically involves multiple sessions spaced out over a few weeks. The injections are usually administered with a fine needle, and the treatment is relatively quick with minimal downtime.

It is important to consult with a qualified practitioner before undergoing mesotherapy to determine the best course of treatment for your individual needs and goals.

Potential Side Effects

Mesotherapy is believed to have minimal side effects due to the direct application to the targeted area. Reported issues include uncertainties about the breakdown of fat cells and the impact of injected substances on the body’s organs and tissues.

Evidence and Cost

Despite being used for decades in Europe, mesotherapy lacks significant scientific evidence. The lack of standardization in substances, doses, and injection frequency poses a challenge. However, the method offers a non-surgical approach with minimal pain, fewer complications, and shorter recovery times, making it a cost-effective alternative to liposuction.

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One of the key benefits of mesotherapy is its ability to target specific areas of concern, such as cellulite or localized fat deposits, with a high degree of precision. This targeted approach can result in more effective results compared to traditional oral medications or topical creams.
The mechanisms behind mesotherapy involve a combination of factors, including the direct delivery of active ingredients to the target area, stimulation of local blood circulation, and triggering of a healing response in the body. These mechanisms work together to improve skin tone, reduce fat deposits, and promote overall skin health.
Different mesotherapy techniques, such as injection lipolysis and intradermotherapy, offer unique benefits and may be more suitable for certain conditions or individuals. For example, injection lipolysis is often used for body sculpting and fat reduction, while nappage technique is preferred for treating cellulite.
Overall, mesotherapy is a versatile and effective treatment option for a variety of cosmetic and medical concerns. By understanding the different approaches and mechanisms involved, individuals can make informed decisions about whether mesotherapy is the right choice for their needs.

The Principle of Mesotherapy

The method of mesotherapy involves injecting small doses of compounds for different medical and aesthetic needs rather than a specific treatment for a single condition. It offers minimal invasiveness, pain, and quick results.

The History and Growth of Mesotherapy

The practice of needle insertion for treatment dates back centuries. Dr. Michel Pistor developed mesotherapy in 1952 for pain and vascular issues, with diverse applications despite limited scientific backing.

Over the years, mesotherapy has gained popularity as a minimally invasive procedure for a variety of cosmetic and medical purposes. It is commonly used for fat reduction, cellulite treatment, skin rejuvenation, hair restoration, and pain management.

Advancements in technology and research have led to the development of specialized mesotherapy cocktails that target specific concerns, making the treatment more effective and personalized. Mesotherapy continues to evolve, with ongoing studies and clinical trials exploring its potential benefits and applications in various fields of medicine.

Off-Label Drug Use in Mesotherapy

Mesotherapists utilize FDA-approved drugs off-label for various conditions, especially in cosmetic dermatology, showing effectiveness in pain management and other health concerns.

In most mesotherapy protocols, lidocaine 1% is used to reduce pain. In France, medications like buflomedil and pentoxifylline are commonly used to improve local circulation and metabolic waste removal. Herbal products such as artichoke, ginkgo biloba, and melilotus are also employed to enhance local blood flow.

The Practice of Mesotherapy for Aesthetic and Medical Conditions

Mesotherapy is a contemporary method for addressing fat loss and cellulite treatment, becoming popular in cosmetic dermatology. It aids in body contouring, skin rejuvenation, wrinkle reduction, and more.

The substances used, such as phosphatidylcholine, carnitine, and hyaluronidase, show significant efficacy in fat reduction and skin revitalization, offering a range of benefits for different conditions.

The approach to body shaping or sculpting involves reshaping the body to reduce fat, increase muscle tone moderately, and reform the silhouette for a lean and firm appearance. Mesotherapy serves as a non-surgical alternative to liposuction, although it does not target large fat volumes. Patients are advised to monitor their fat intake and engage in physical exercises alongside the treatment, which may require several sessions ranging from 200 to 600 dollars each.

Cellulite refers to the dimpled skin appearance caused by fat pressing against connective tissue.

Substances like pentoxifylline, carnitine, coumarin, hyaluronidase/collagenase, calcium pyruvate, aminophylline/caffeine, artichoke, melilotus, or ginkgo biloba are used for reducing cellulite.

Scientific Findings and Treatment Approaches

Studies and Clinical Applications of Mesotherapy

In a pilot study on a small group (n=20), mesotherapy with multiple microinjections of hyaluronic acid showed efficacy against skin photoaging, confirmed by ultrasound imaging, though individual responses varied.

Treatment of Alopecia and Expanded Applications

Injections of minoxidil, finasteride, lidocaine, multivitamins, T3/T4 are employed for alopecia treatment.

The mesotherapy concept has been extended to other areas, such as interval vaginal injections of rFSH every 3 days successfully used in women undergoing IVF treatment, primarily to reduce hospital visits.

The wide array of pharmaceutical substances, plant extracts, vitamins, and other ingredients used point to a lack of standardized mesotherapy formulations, with components varying based on indications and practitioner experience. The proposed mechanisms of these components are yet to be substantiated. For detailed information on indications, drugs, dosages, and techniques, refer to medical textbooks.

Key Principles and Techniques

Besides the discussed mechanisms of specific components, mesotherapy is based on a general principle.

“The dermis acts as a common denominator for three working blocks – circulatory, neuro-vegetative, and immunological. By targeting each of these blocks, mesotherapy is thought to correct functional imbalances that lead to suspected pathologies.”

In addition to targeting the circulatory, neuro-vegetative, and immunological blocks, mesotherapy also involves the use of microinjections to deliver small doses of various medications, vitamins, minerals, and amino acids directly into the mesoderm (middle layer of the skin). This targeted delivery allows for a more precise treatment of specific areas and conditions, resulting in faster and more effective results.

Treatment Sessions and Injection Techniques

Each mesotherapy session involves superficial injections of substances using specialized short needles and specific techniques directly over the affected structures. Hundreds of injections are given, with the number varying based on indications. Typically, acute cases like sports injuries require 1-3 sessions, while chronic conditions like cellulite necessitate 10-15 sessions with maintenance every 6 months or year.

Three different techniques are commonly used.

The Pistor Technique

The first technique, described by Dr. Pistor, includes perpendicular injections of 0.02 to 0.05 ml of the solution into the skin (4 mm deep), spacing 1 to 2 cm apart.

The “Salt Sprinkling” Technique

This method involves more superficial (2 mm deep) injections with a 4 mm needle, covering a larger area. The injections are made at a 45-degree angle to the skin, with slight constant pressure on the plunger, and the wrist is quickly moved back and forth (mimicking sprinkling salt or a sewing machine action). A drop of the solution is introduced at each site, making it a more painful procedure for the patient.

Additional Injection Approaches

Microneedling is a superficial technique, reaching a depth of 1 mm, that does not penetrate the basal layer of the skin. It involves using a needle sized 27 to 31 gauge with a tip directed away from the skin, moving with gentle, positive pressure on the plunger. This is done in a grid-like pattern every 1 cm across the affected area.

Multiple injections of small doses of drugs in precise locations in one session require a high level of skill from the therapist. To overcome this challenge, many practices in Europe and South America use a device called the ‘mesogun’. The advantages of the mesogun include faster injections, precise dosage delivery, consistent penetration depth, and greater comfort for both the physician and the patient. Some experts use a special technique called ‘mesoperfusion’, where the same dose is injected over 10 minutes instead of 30 seconds in a regular session.

ADVERSE EFFECTS[26,27]

It is claimed that side effects after mesotherapy are extremely rare among experienced specialists, and if they occur, they are mild. Despite multiple injections in mesotherapy, the main reason for rare adverse effects is a much lower dose compared to a single large dose used in modern medicine.

Non-specific common side effects include nausea, vomiting, diarrhea, mild pain, skin hyperesthesia, edema, itching, redness, and painful subcutaneous nodules at the injection site.

Pigmentation problems include post-inflammatory hyperpigmentation and urticaria pigmentosa, which can persist for many months and can be very distressing, although not serious. Rare occurrences include full-thickness skin and fat tissue necrosis.

Hyperallergic reactions, such as immediate or delayed (especially to hyaluronidase, collagenase), itchy, maculopapular rash away from the treated area (phosphatidylcholine allergy), are also reported.

Specific side effects due to individual components, such as isoprenaline, yohimbine, aminophylline, anxiety, tremors, palpitations, muscle cramps due to potassium loss, phosphatidylcholine causing mild, short-lived elevation.

A new technique or drug is accepted if it is more effective, safer, and more cost-effective. The main problem with mesotherapy is the lack of scientific research compared to existing treatment methods. There is a lack of knowledge about the effectiveness, mechanism of action, and consequences of mesotherapy.

Even a small amount of available evidence of low significance or even insufficient is not encouraging. Additional research is needed to recognize mesotherapy as a standard treatment method.

Approximately 16,000 US doctors use mesotherapy in their daily practice. The growing number of doctors trained in mesotherapy, the publication of a specialized journal, and the establishment of numerous centers worldwide attest to its status. Mesotherapy is gaining popularity among therapists and the public.

Permission to display images before and after mesotherapy of clinical conditions has not been obtained. However, readers can find such photos on Google by entering relevant keywords.

Acknowledgments

I want to thank Dr. Ratinder and Dr. Nandita for their valuable comments and Dr. Manikandan for help in literature search.

Footnotes

Source of support: Not applicable

Conflict of interest: Not declared

Acknowledgments: We would like to thank all the participants who volunteered for this study. Their contribution was invaluable.

Author contributions: J.S. and M.K. designed the study. A.B. and C.D. collected and analyzed the data. E.F. wrote the manuscript. All authors approved the final version for submission.

REFERENCES

Articles from the journal Pharmacology & Pharmacotherapeutics are provided courtesy of Wolters Kluwer – Medknow Publications.