Mesotherapy

Mesotherapy (from Greek mesos, "middle", and therapy from Greek therapeia, "to treat medically") is a non-surgical cosmetic medicine treatment. Mesotherapy employs multiple injections of pharmaceutical and homeopathic medications, plant extracts, vitamins, and other ingredients into the subcutaneous fat. Mesotherapy injections allegedly target adipose fat cells, apparently by inducing lipolysis, rupture and cell death among adipocytes.^[1]

Usage

There are published studies on the clinical treatments and effects of these medications and numerous cocktails of combined chemical compounds on the body have been reported in Europe and South America for several years. There is no conclusive research proof that these chemical compounds work to target adipose (fat cells) specifically. Cell lysis, resulting from the detergent action of deoxycholic, may account for any clinical effect.^[2]

Substances used include:

• T3-T4 thyroid,
• Isoproterenol
• Aminophylline
• Pentoxifylline
• L-carnitine
• L-arginine
• Hyaluronidase
• Collagenase
• Yohimbine
• Lymphomyosot
• Co-enzyme cofactors
• Dimethylethanolamine
• Gerovital
• Glutathione
• Tretinoin
• Alpha lipoic acid
• Vitamin C
• Procaine
• Lidocaine
• Ginkgo biloba
• Melilotus
• C-adenosine monophosphate
• Multiple vitamins
• Phosphatidylcholine
• Trace mineral elements
• Carbon dioxide
• Mesoglycan

History

Dr. Michel Pistor (1924–2003) performed clinical research and founded the field of mesotherapy. Multi-national research in intradermal therapy culminated with Pistor's work from 1948 to 1952 in human mesotherapy treatments. The French press coined the term Mesotherapy in 1958. The French Academy of Medicine recognized Mesotherapy as a Specialty of Medicine in 1987. Popular throughout European countries and South America, mesotherapy is practiced by approximately 18,000 physicians worldwide.

Criticism

Mesotherapy treatments have been performed throughout Europe, South America, and more recently the United States for over fifty years. However physicians have expressed concern over the efficacy of mesotherapy, arguing that the treatment hasn't been studied enough to make a determination. The primary issue is that mesotherapy for the treatment of cosmetic conditions hasn't been the subject of gold standard clinical trials; however the procedure has been studied for the pain relief of other ailments, such as tendonitis, tendon calcification, dental procedures, cancer, cervicobrachialgia, arthritis, lymphedema, and venous stasis.^[3] Further, there have been case series and numerous medical papers on the mesotherapy as a cosmetic treatment, as well as studies that employ the ingredients used in mesotherapy.^[3][4]

The other side of the debate is expressed by Rod Rohrich, M.D., Chairman, Dept. of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas: "There is simply no data, no science and no information, to my knowledge, that mesotherapy works." The American Society of Plastic Surgeons issued a position statement not endorsing mesotherapy, but this non-endorsement is the subject of some controversy. Since mesotherapy isn't a surgical treatment but, rather, a non-invasive alternative to plastic surgery, the treatment competes with plastic surgery for the same patients.

The FDA cannot control the use of practitioners injecting various mixtures into patient's bodies because this practice falls under the jurisdiction of state medical boards. This is the case because the mesotherapy is considered a "procedure" by state medical boards. The FDA, on the other hand, is mandated to approve foods, dietary supplements, drugs, vaccines, biological medical products, blood products, medical devices, radiation-emitting devices, veterinary products and cosmetics.

Dr. Robin Ashinoff, speaking for the American Academy of Dermatology, says "A simple injection is giving people false hope. Everybody's looking for a quick fix. But there is no quick fix for fat or fat deposits or for cellulite." The American Society for Dermatologic Surgery informed its members in February 2005 that "further study is warranted before this technique can be endorsed."

Many dermatologists and plastic surgeons are alarmed about the growing profile of mesotherapy. "No one says exactly what they put into the (syringe)," says Naomi Lawrence, a derma-surgeon at the University of Medicine and Dentistry of New Jersey. "One drug they often use, phosphatidylcholine, is unpredictable and causes extreme inflammation and swelling where injected. It is not a benign drug." USAToday 8/4/2004.

It is currently banned in a number of South American countries. Even Brazil, which is less strict than the USA in drug approvals, has banned the drug for these purposes. USAToday 8/4/2004.

In Australia, an alternative therapy salon is being investigated by the Health Department after several clients developed skin abscesses on the calves, buttocks, thighs, abdomen, shoulders, face and neck from the treatment, with one patient also developing a mycobacterial infection.^[5]

Recently the French National Agency of Health (HAS) has banned Mesotherapy as a method for removing fat deposts and declared the method as "dangerous for human health". HAS is a non-government organisation, so an approval from the French government on the ban was needed to become official. The French health ministry made an official ratification of the ban on the 13. 06. 2011 with an Ordinance №2011-382. Esthetic surgeon from France and Austria have long expressed concerns about the treatment and labelled it "a potencially dangerous procedures with no proven beneficial effect". The ban only affects the use of non-invasive lipolitic treatments with physical methods (lasers infrared light and other methods). The ban is only valid in France so far however surgeons in the USA have long been conducting studies and warning society about the dangers of Mesotherapy.

Clinical studies

In a prospective study, 10 patients underwent four sessions of facial mesotherapy using multivitamins at monthly intervals. This study found that there was no clinically relevant benefit.^[6]

References

1. ^ Rittes PG, Rittes JC, Carriel Amary MF. Aesthetic Plast Surg. 2006 Jul-Aug;30(4):474-8.Injection of phosphatidylcholine in fat tissue: experimental study of local action in rabbits. PMID 16858660
2. ^ Rotunda AM, Kolodney MS. Dermatol Surg. 2006 Apr;32(4):465-80.Mesotherapy and phosphatidylcholine injections: historical clarification and review. [PMID 16681654]
3. ^ ^{a b} "Mesotherapy and Phosphatidylcholine Injections: Historical Clarification and Review," Adam M. Rotunda, MD and Michael S. Kolodney, MD, PhD
4. ^ Mesotherapy Worldwide: Studies and Research Papers
5. ^ 26/6/08 "Alternative cosmetic therapy investigated"
6. ^ Amin S, Phelps R, Goldberg D (2006). "Mesotherapy for facial skin rejuvenation: a clinical, histologic, and electron microscopic evaluation". Dermatol Surg 32 (12): 1467–72. doi:10.1111/j.1524-4725.2006.32353.x. PMID 17199654. 

External links

• American Board of Mesotherapy and Cosmetic Medicine; Board Certified Specialists
• American Board of Aesthetic Mesotherapy
• International Meso-Lipotherapy Society
• Swiss Society of Mesotherapy - A list of international mesotherapy associations