Mesotherapy, the Injectable Rejuvenation

Body fatThe success of injectable cosmetic Botox® in erasing furrowed brows, crow’s feet, and wrinkled lip lines has prompted growing interest in other subcutaneous therapies to achieve new kinds of cosmetic results.

The practice of injecting medications under the skin for specific conditions is called mesotherapy, and it is one of my special interests. Over the past 6 years, I’ve successfully treated hundreds of patients, authored numerous peer-reviewed scientific publications, and made more than 60 professional presentations about mesotherapy’s emerging uses, successes, and limitations.

Physicians have been practicing medicinal mesotherapy for more than 5 decades, particularly in Europe. Now there is renewed interest in mesotherapy-style treatments for dermatologic and aesthetic purposes in the United States – to treat cellulite and sun damage (photoaging), for example. But by far the most interest is being generated by injectable treatments for fat loss, commonly called injection lipolysis (or Lipodissolve™).

Injection lipolysis is a still-emerging treatment, with limited long-term research and findings about safety or effectiveness. Consequently, there are myths, controversies, and misunderstandings about it. My goal here is to raise awareness and knowledge about this burgeoning field, clarify information, define terms, dispel myths, and explore more about the impact of such therapies.

The prefix meso means middle, and mesotherapy injections are made in the middle layer of the skin’s surface, sending specific medicinal mixtures directly to affected areas, thereby reducing or avoiding negative effects to the entire body (systemic effects). The treatment was pioneered in 1952 by French physician Dr. Michel Pistor, who used mesotherapy for both medical and cosmetic conditions. It is still a well-respected treatment in France, especially for pain-related musculoskeletal conditions such as tendonitis and arthritis, often suffered by professional athletes as well as aging populations. 

Mesotherapy remained a largely French practice until the term was used to also describe a technique pioneered by the Brazilian dermatologist Dr. Patricia Rittes in 2001. Dr. Rittes successfully used a unique combination of ingredients that were found to “melt” fatty deposits after injection. This is where the confusion of terms between mesotherapy and injection lipolysis / Lipodissolve began.

The difference between mesotherapy and injection lipolysis is the intended use and the particular blend of medications injected. For example, mesotherapy uses a wide range of customized ingredients, including anti-inflammatories, analgesics, herbs, vitamins, and other compounds with purported medical benefits that can often include life-changing pain relief and purported cosmetic improvements.

I had the benefit of being co-author, with Glynis Ablon MD, of the first US patient study on fat dissolution injectables as well as studying these compounds in the lab. Our research team succeeded in identifying and isolating key active fat loss ingredients, simplifying the formula preparation. The concentration of natural detergents is proven to cause fat cells to break apart, after which the body absorbs the fat over weeks and months. Over the past year, my colleagues and I published compelling data showing there is great promise in such techniques.

Lipolysis is a distinct treatment for distinct conditions, specific to fat and body-contouring, with strong appeal for those who wish to avoid surgery. For example, I’ve treated many satisfied patients with lipolysis – rather than an expensive surgical neck lift – to “dissolve” under-chin fat deposits with very satisfying results.

The best treatment areas for lipolysis include smaller isolated fat deposits under the chin and upper back (bra strap) fat. The best treatment candidates need to be patient because visible results occur over time, with a series of 4–6 monthly treatments.

While it may be tempting for some doctors to dismiss, injectable treatments are becoming promising options for localized fat loss. Making visible changes in the body with injection treatment is a new paradigm for how we think about body sculpting and age-related cosmetic issues. 

However, injection lipolysis is not yet FDA approved, which means there are no regulations about what is injected and how it is injected, further adding to the controversy. 

Some practitioners import medications approved for use in other countries but not the US. Many lipolysis providers rely on compounding pharmacies to blend custom injection formulations, developed for the specific needs of individual patients. Compounding pharmacies are subject only to local and state regulations, and medications prepared there are not subject to FDA approval – or tested for safety and efficacy.

That is why it’s very important to consult only a board-certified physician or dermatologist if you’re considering lipolysis. Work only with physicians who are experienced and can provide to you the exact name of the medications and their source(s).

Oftentimes, radical medical innovations are accompanied by controversy, fallacies, and misinformation, and such is the case with lipolysis. But from what I see, injectable treatments for fat loss may one day become an approved, well-studied alternative to more invasive and expensive procedures.

Published on 10/08/2009 | Last updated on 12/20/2016