According to published statistics from the British Beauty Council (2023), the cosmetic and personal care sector supported a total GDP contribution of £24.5 billion in 2022 in the UK; it has also been reported that 43% of UK adults increasingly consider non-surgical procedures to be a normal part of their beauty and personal care routine, which is mirrored by a 40% drop in cosmetic surgeries since 2015, according to the British Association of Aesthetic Plastic Surgeons (Mintel Group, 2021). Proposed as a non-invasive alternative to address a variety of patient concerns, including cellulite, body sculpting, weight reduction and skin rejuvenation, mesotherapy remains a controversial therapy, with some arguing that it is ineffective at best and potentially dangerous at worst (Brown, 2006; Konda and Thappa, 2013). Mesotherapy is a minimally invasive method of drug delivery that consists of multiple intradermal or subcutaneous injections of a mixture of compounds in minute doses. Plant extracts, homeopathic agents, pharmaceuticals, vitamins and other bioactive substances can be used, but alcohol- or oil-based substances should not be used for mesotherapy, because of the risk of cutaneous necrosis (Konda and Thappa, 2013).
For applications such as cellulite reduction, the American Academy of Dermatology (2024) states that the efficacy of mesotherapy is not proven and that side effects are common, including redness and swelling, tender lumps beneath the skin, infection, allergic skin reaction and skin changes. Indeed, in Australia, an alternative therapy salon was investigated by the local health department after several clients developed skin abscesses on the calves, buttocks, thighs, abdomen, shoulders, face and neck after undergoing mesotherapy for cellulite reduction, with one patient also developing a mycobacterial infection (ABC News, 2008). With that said, it is relevant to note that, in a first consultation launched in September 2023 to ascertain views on the scope of the proposed licensing scheme for non-surgical cosmetic procedures, the Department of Health and Social Care (2023) initially categorised mesotherapy (presumably for the purposes of skin rejuvenation) as a procedure with the lowest risk of complications.
» Mesotherapy is a minimally invasive method of drug delivery that consists of multiple intradermal or subcutaneous injections of a mixture of compounds in minute doses «
» Mesotherapy has been used to treat localised pain, and is also being widely employed in cosmetic dermatology to promote skin rejuvenation and hair growth and treat pigmentary disorders «
What are the applications?
Mesotherapy has been used to treat localised pain, and is also being widely employed in cosmetic dermatology to promote skin rejuvenation and hair growth and treat pigmentary disorders (Gupta et al, 2023). However, substantive data are lacking, and investigations into the efficacy of mesotherapy are mixed.
Skin rejuvenation
In a prospective study aimed to evaluate the clinical effect of mesotherapy when applied to periorbital wrinkles and to quantitatively evaluate histological changes in the skin, six participants underwent a 3-month course of treatment; however, clinical evaluation of participants at baseline, end of treatment and 3 months post-treatment revealed no significant differences, and histological and immunostaining analysis of collagen types I, III and VII, newly synthesised collagen, total elastin and tropoelastin showed no statistically significant changes (P > 0.05) after mesotherapy injection (El-Domyati et al, 2013). Contrastingly, in a similar study involving 18 female participants who received five injection sessions over 90 days, a statistically significant decrease in the depth of crow's-feet wrinkles (43.3%) and in pore size (58.5%) was observed using 3D visualisation and macrophotography techniques; similarly, using high-frequency ultrasound, significant increases in dermal thickness (20%) and density (24%) were observed, indicating an improvement in skin firmness (Grand-Vincent et al, 2017).
Hair loss treatment
In a retrospective study comparing the efficacy of platelet-rich plasma (PRP) and mesotherapy products in the treatment of androgenetic alopecia, certain parameters (hair thickness, hair density and hair count) on the frontal and vertex areas of the scalps of 72 participants were assessed before and after 6 months (Stefanis et al, 2024). Significant intragroup and intergroup variability was demonstrated: statistically significant increases in all variables were observed in 22 patients who received a mesotherapeutic treatment of DermaHeal Stem C'Rum HL® (Caregen Co., South Korea), particularly in the frontal region, while 16 patients receiving a different mesotherapeutic formulation (allstem.® (Scimed Pharma CY Ltd, Cyprus)) demonstrated significantly increased vertex hair density (Stefanis et al, 2024). Pairwise comparisons between both PRP and mesotherapy treatments were conducted to ascertain the changes in the measured parameters pre- and post-treatment, but any differences found did not reach significance (Stefanis et al, 2024).
Additionally, further reinforcing the inconclusive nature of mesotherapy's reported efficacy, a systematic review encompassing 27 research articles on the use of mesotherapy as a treatment for hair loss concluded that, while several studies report statistically significant improvements in hair growth after treatment, there is currently a lack of standardised regimens, leading to an absence of consistency even when the same agent is used (Gupta et al, 2023). Indeed, no conclusions or correlations could be made between the regimens used and the efficacies observed, due to the high degree of variability between studies (Gupta et al, 2023). Additionally, eight of the 27 studies included in this systematic review reported adverse effects associated with mesotherapy, which included hair loss at the injection site, oedema, swelling, scalp melanoma and frontal fibrosing alopecia (Gupta et al, 2023).
Conclusions
Without substantive evidence in the form of large-scale and controlled clinical trials, it is difficult to draw any definitive conclusions on the efficacy—and, indeed, the safety—of mesotherapy. There are indications that lower doses and injection frequency and localised administration are factors that can improve the utility of mesotherapy (Gupta et al, 2023), but practitioners should proceed with caution, as mesotherapy has not received regulatory approval from agencies such as the US' Food and Drug Administration or Health Canada for the majority of its alleged applications. This is particularly relevant given the reports of severe adverse effects in response to some agents used in mesotherapy, and the inconsistencies in formulations applied in mesotherapy. To reduce the possible development of allergic reactions to the therapeutic agents or the preparations being injected, pre-treatment allergy testing should be considered (Gupta et al, 2023). While there is no consensus on injection technique in mesotherapy, some studies recommend a depth of intradermal injection of 1–1.5 mm, with individual variations, and an injection angle of 30 degrees to inoculate in the dermis without affecting the subcutaneous layer (Mammucari et al, 2020).