Mesotherapy, which is the injection of substances locally into mesodermally derived subcutaneous tissue, developed from empirical observations of a French physician in the 1950s. Although popular in Europe for many medical purposes, it is used for local cosmetic fat reduction in the United States. This paper reviews manuscripts indexed in PubMed/MEDLINE under '
mesotherapy', which pertains to local fat reduction. The history of lipolytic
mesotherapy, the physiology of body fat distribution, the mechanism of action of different lipolytic stimulators and their increased efficacy in combination are reviewed.
Mesotherapy falls into two categories. Lipolytic
mesotherapy using lipolytic stimulators requires more frequent treatments as the fat cells are not destroyed and can refill over time. Ablative
mesotherapy destroys fat cells with a
detergent, causes
inflammation and
scarring from the
fat necrosis, but requires fewer treatments. The historic and empiric mixing of
sodium channel blocking local anaesthetics in
mesotherapy solutions inhibits the intended lipolysis. Major
mesotherapy safety concerns include injection site
infections from poor sterile technique. Cosmetic
mesotherapy directs the area from which fat is lost to improve self-image. Studies were of relatively small number, many with limited sample sizes. Future research should be directed towards achieving a Food and Drug Administration indication rather than continuing expansion of
off-label use.