LAS VEGAS There are not enough data to recommend mesotherapy to patients, although some evidence supports a specific forminjected lipolysisfor localized fat reduction, according to two presentations at an international symposium on cosmetic and laser surgery.
Mesotherapy is touted for many indications worldwide, including cellulite reduction and pain management. Confusion abounds, however, because people often refer to mesotherapy and injected lipolysis interchangeably, said Dr. Paul T. Rose of Tampa.
"Oftentimes I am asked: Does mesotherapy work?" said Dr. Adam M. Rotunda of the division of dermatology at the University of California, Los Angeles. "We cannot say it works or does not workit is such a general term."
An injected combination of the soy-derived phospholipid phosphatidylcholine (PC) and the solvent sodium deoxycholate (DC) "is well proven" for localized fat lysis, Dr. Rose said. He and colleague Dr. Michael Morgan assessed punch biopsies from a patient after PC/DC injections, and histology showed destruction of fat (J. Cosmet. Laser Ther. 2005;7:179). "There is a profound inflammatory response with neutrophils, plasma cells, and hopefully, macrophages to eat up the fat," he said.
Another study of 30 patients demonstrated some benefit of this combination for correction of lower eyelid bulging (Dermatol. Surg. 2001;27:3912), Dr. Rotunda said. An open-label study of 43 patients who received a "pretty aggressive" regimen of up to 100 mL PC/DC per treatment session demonstrated some improvements in abdominal fat, he said.
"I'm not impressed with the abdomenyou need a significant amount. I am impressed with jowl-area results," Dr. Rotunda said. Other commonly treated areas include inferior orbital fat, chins, arms, flanks, lateral and medial thighs, and knees.
Even with this evidence, more research is needed. "Most of these studies are unblinded, open case series. But we are moving in the direction of having peer review literature," Dr. Rotunda said. For example, Dr. David Goldberg and his associates conducted a study in 10 patients who received four monthly injections of multivitamin and conjugated hyaluronic acid for facial rejuvenation (Dermatol. Surg., in press). Although thickened collagen fibers were noted, "no clinical benefits were seen," Dr. Rotunda said.
Intravenous PC can lower blood lipids, and a similar mechanism of action might lyse subcutaneous fat. "In our lab, however, phosphatidylcholine has not demonstrated any antifat property. Sodium deoxycholate, however, is a detergent known to lyse fat [Dermatol. Surg. 2004;30:10018]. So could this solvent actually be the active ingredient?" Dr. Rotunda asked.
"We are working on a double-blind study of PC vs. DC [for submental fat] to see if you need PC at all," Dr. Rotunda said. He disclosed a relationship with Kythera Biopharmaceuticals Inc., codeveloper of a patent-pending process owned by the University of California, Los Angeles, for the use of detergent in treating fat. Dr. Rose had no relevant disclosure.
Injected lipolysis is contraindicated in patients on blood thinners or those with severe hypertension or cardiac disease, HIV, severe renal disease, allergies to medication, or unrealistic expectations, Dr. Rose said. "This is not a procedure for profound weight loss. If I have a patient come in and they are markedly obese, I tell them mesotherapy is not an option." The therapy can be an adjunct to liposuction or other procedures, he added.
Patients can receive the treatment every 2- 4 weeks at up to four areas at a time. "It is not magic. It can be four or five treatments," Dr. Rose noted. It is important to inform patients that they can get significant swelling and that bruising almost always occurs, he said.
Other effects, such as erythema, burning, tenderness, a jelly-like edema post injection, and nodularity, will go away within weeks, Dr. Rotunda said.
Mesotherapy Is a No Go for Cellulite
Not enough evidence of efficacy exists to recommend mesotherapy for treatment of cellulite.
Although some evidence supports a form of mesotherapy for local fat lysis, "I am far more skeptical about this area, it's more sketchy. Objective data are lacking for cellulite," said Dr. Rose.
Proponents of mesotherapy for cellulite say connective tissue dissolution can degrade and smooth out skin, Dr. Rotunda said, "but there are no published data that demonstrate improvements of 'skin dimpling.'"
"There is a lack of controlled studies or histologic studies [but] there are people doing this," Dr. Rose said.
"Unscrupulous individuals are administering this," agreed Dr. Rotunda.
"Until further studies are performed, patients considering mesotherapy for cellulite must be aware that the substances currently being injected to treat this cosmetically disturbing, but medically benign, condition have not been thoroughly evaluated for safety or efficacy," Dr. Rotunda and his colleagues said in a review article on injectables used for cellulite (J. Cosmet. Laser Ther. 2005;7:14754).