Journal of Cosmetic and Laser Therapy, 2011; 13: 142–153

ORIGINAL ARTICLE

Evaluation of mesotherapeutic injections of three different

combinations of lipolytic agents for body contouring

ZEKAYI KUTLUBAY

Lazerart Clinics, Division of Dermatology, Istanbul, Turkey

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Abstract
Background: There has been significant interest recently in the technique of mesotherapy as a method of ‘melting fat’ for
body contouring. Objective: The aim of this study was to evaluate the safety, efficacy and lipolytic potential of several com-
pounds commonly used in cosmetic mesotherapy. Methods: A total of 75 women (mean age: 33 years) were separated
randomly into three mesotherapy groups. Injections were performed for 15 treatments once a week. The main component
of each cocktail was phosphatidylcholine/deoxycholic acid for group 1, caffeine for group 2, and Conjonctyl® for group 3.
Outcome was evaluated by weight, body fat percentage (BFP), circumference measurements, and patient questionnaires.
Results: Seventy-two of all the patients (96%) showed a circumference loss. An average circumference reduction of 4.41 cm
per site for group 1, 2.99 cm for group 2, and 2.10 cm for group 3 was achieved. Mean body circumference loss was
statistically significant, with p ⬍ 0.00. Weight loss was 5.33 ⫾ 1.09 kg for group 1, 3.74 ⫾ 1.51 kg for group 2, and 2.82 ⫾ 1.43 kg
for group 3. Seventy-four subjects (98.7%) showed a BFP decrease. A questionnaire indicated high patient satisfaction (63%).
For personal use only.

No patient showed irregularities, dimples or any serious side effects after treatment. Conclusion: Mesotherapy is a well-tolerated
and effective alternative treatment modality for reducing the diameter of body circumference.

Key Words: body contour, cosmetic dermatology, lipolysis, mesotherapy

Introduction Mesotherapy is a minimally invasive technique

Mesotherapy is a recently introduced treatment that
involves the delivery of pharmacologic drugs or sub-
stances into the mesoderm, which is the layer of fat and
connective tissue under the skin (1). Mesotherapy using
different substances has been advocated by some to
treat a variety of conditions as varied as chronic pain,
psoriasis, cellulite, weight loss, and local obesity con-
trol. In particular, mesotherapy has been advocated by
some physicians and used as a nonsurgical alternative
to liposuction for several years. The pharmacologic
substances most frequently injected for body contour-
ing are phosphatidylcholine (PC), deoxycholate (DC),
isoproterenol, aminophylline, caffeine, L-carnitine,
buflomedil, calcitonin, and others. Despite the num-
ber of anecdotal reports and data suggesting that the
components of traditional mesotherapy formulations
might be effective, this study performed a clinical trial
to determine the effect of different mesotherapy cock-
tails on body contouring (2–4).
that consists of the intra- or subcutaneous injection of
variable mixtures of natural plant extracts, allopathic
medicines, homeopathic agents, pharmaceuticals, vita-
mins, enzymes, nutrients, antibiotics, hormones, and
other bioactive substances in microscopic quantities
through dermal multipunctures (1,5,6).
Mesotherapy has been used for several years in
Europe and South America for body contouring.
Its introduction and application is about 10–15 years
in Turkey.
Mesotherapy describes a technique by which mix-
tures of medications and other compounds are injected
directly into a diseased area so that the systemic effects
of oral or intravenous medications can be avoided (7).
The composition of common mesotherapy formu-
lations is selected and mixed in a ‘cocktail’ before
injection (8).
Mesotherapy is a non-surgical, relatively painless
injection technique with a broad range of applications.

Correspondence: Zekayi Kutlubay, Lazerart Güzellik Merkezi, Aytar cad. Aydın sok. Fırat i merkezi, D:10 1. Levent, Istanbul, Turkey. Fax: 90 212 3259676.
E-mail: zekayikutlubay@hotmail.com; zekayikutlubay@gmail.com

(Received 13 December 2010 ; accepted 14 May 2011)

ISSN 1476-4172 print/ISSN 1476-4180 online © 2011 Informa UK, Ltd.
DOI: 10.3109/14764172.2011.594059

The true mechanism of mesotherapy remains unknown.
Mesotherapy promotes the body’s circulatory, lym-
phatic, and immune system to create a biological res-
ponse and reverse abnormal physiology. Mesotherapy
is a safe and effective alternative for the treatment of
cellulite, weight loss, hair loss (alopecia), and face and
neck rejuvenation. Mesotherapy is virtually painless,
and requires no postoperative recovery time. Patients
notice an improvement in skin quality, less dimpling
of the skin, and weight reduction, including a loss of
one to two clothing sizes (9).
The use of mesotherapy for body contouring, spot
weight loss, and overall weight reduction typically
involves multiple injections of lipolytic agents into the
area selected for contouring. Dermatologists have been
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using similar injection techniques to treat alopecia
areata, keloids and hypertrophic scars with steroids
(3,6). Lipolytic stimulants are usually used for lipoly-
sis and the treatment of ‘cellulite’, which may be described
as the cutaneous dimpling of the thighs, buttocks, and
hips seen predominantly in women. Each session may
involve up to several hundred injections administered
at various skin levels (epidermis, dermis, subcutaneous
layer) by syringe (5,8).
Despite the fact that there is very little scientific
evidence sustaining its widespread use, the field of meso-
For personal use only.
therapy and nonsurgical lipolysis has grown enormously
in the past few years, becoming a common method in
cosmetic medicine. It gained recognition primarily in
pain management, sports medicine, and rheumatology.
Its use in cosmetic medicine to “eliminate cellulite,
reduce and contour fat, promote weight loss, treat aging
skin and redundant (sagging) skin, reduce acne scars
and stretch marks and rejuvenate the hands and neck”
is gaining in popularity and acceptance (5).
Materials and methods
This randomized, prospective, clinical trial was carried
out on volunteers who had localized obesity and fat
deposits.The study included 75 women seeking weight
loss and slimming (mean age: 33 years; range: 20–60
years) at a private clinic, between June 2007 and
February 2009. All the volunteers provided written
informed consent and accepted the possibility of side
or adverse effects, including infections, pain, bruising
and an ineffective result associated with the procedure.
Dietary modification, hormone replacement ther-
apy, exercise, and nutritional supplements are often
used in conjunction with mesotherapy. No specific diet,
Table I. List of contents of the mesotherapy cocktails tested according to the groups.
Groups Content
Group 1 5 ml of Lipostabil® N 5 ml of normal saline 3 ml of L-carnitene
Group 2 5 ml of Cellucare® 5 ml of normal saline 1 ml of procaine-2%
Group 3 5 ml of Conjonctyl® 5 ml of chophytol-2% 2.5 ml of buflomedil-1% 2.5 ml of
Mesotherapeutic injections for body contouring 143
hormone therapy or exercise plans were given to the
patients. They continued routine social activities. No
other type of treatment of fat deposits (e.g. liposuction,
ultrasound, vigorous massaging) was allowed during
the study period.
Exclusion criteria were pregnancy, breast-feeding,
insulin-dependent diabetes, a history of strokes, recent
cancer, thromboembolic phenomena, patients on med-
ications such as aspirin, warfarin, and heparin, patients
with lymphedema or periodic swellings due to lym-
phatic problems, and an unrealistic expectation of the
patient.
Patients were separated randomly into three meso-
therapy groups. Each group was composed of 25 patients.
Patients in each group were injected with different
mesotherapy cocktails (Table I). Group 1 patients were
given a 15-ml cocktail made up of 5 ml of Lipostabil®
N, 5 ml of normal saline, 3 ml of L-carnitene, and 2 ml
of 2% procaine. The Lipostabil N brand (Artesan
Pharma, Lüchow, Germany) contains 5% PC (50 mg/
ml) and 4.75% deoxycholic acid (DC) (47.5 mg/ml)
with 0.9% benzoyl alcohol and saline. Group 2 patients
were given an 11-ml solution containing 5 ml of Cel-
lucare®, 5 ml of normal saline, and 1 ml of 2% procaine.
The Cellucare brand (Revitacare Laboratory, Saint
Ouen l’Aumône, France) contains 250 mg of caffeine
and 20 mg of hyaluronic acid and trace elements:
Mn-Zn-Co in a vial of 5 ml. Group 3 patients were given
a 17-ml solution containing 5 ml of conjonctyl, 5 ml
of chophytol, 2.5 ml of buflomedil, 2.5 ml of L-carnitene
and 2 ml of 2% procaine.
Before the procedure, the patients did not use local
anesthetic cream or an ice massage to reduce the level
of pain. The solutions were injected into the dermis
and subcutaneous layer – between 6 mm and 13 mm in
depth. The treatment was repeated in the same man-
ner once a week for 15 weeks.
In addition, weight and body fat percentages (BFP)
were analyzed by Gaia 359 Plus™ (body composition
analyzer; Jawon Medical, Kyungsan-City, Korea).
The size and location of the fat deposits were examined
and the circumference was measured. Perimetric cir-
cumferential thickness measurements of 10 body sites
(i.e. upper belly, lower belly, waist, hip, right thigh,
left thigh, right calf, left calf, right knee and left knee)
were obtained before the application and 1 month after
the 15th session of treatment. Measurements were
obtained at a specific and consistent distance from an
anatomic bony landmark to ensure a consistent loca-
tion, and the total and mean changes in body circum-
ference were calculated.To eliminate any interobserver
Total volume
2 ml of procaine-2% 15 ml
11 ml
2 ml of 17 ml
L-carnitene-20% procaine-2%
 144 Z. Kutlubay

differences, the same nurse, who was blinded to this
study, measured the circumferences before treatment
and at 1 month after the last mesotherapy session. Fur-
thermore, a mean body circumference loss was deter-
mined for each area, and these 10 parameters were then
averaged into a mean index of average overall loss.
In addition, photographs were taken before and after
the procedure to document the changes resulting from
treatment.
The surfaces were cleaned with alcohol before and
after treatment. All the injections were performed man-
ually by means of needles and syringes appropriate for
mesotherapy. Each patient was treated by the same
dermatologist.
The injections were performed in an outpatient set-
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at the hips (5.35 cm), whereas the minimum loss was
obtained at the left knees (1.89 cm) in all three groups
(Tables II and III). The differences between the base-
line and the after-treatment mean total body circum-
ferences were statistically significant for all three
groups with p ⬍ 0.00.
Circumferential reductions at the hip were achieved
as 7.66 ⫾ 1.18 cm (minimum 5.8 cm and maximum
10.4 cm loss) for group 1. It was 4.57 ⫾ 1.73 cm for
group 2 and 3.83 ⫾ 1.81 cm for group 3.
Average circumference reductions of 4.41 cm per
site for group 1, 2.99 cm for group 2, and 2.10 cm for
group 3 were achieved when comparing all of the mea-
sured body sites (Figures 1, 2 and 3).
After completing all of the sessions, 72 patients

ting with the patient lying on the operating table. Using (96%) had lost weight and three patients (one in group
30-gauge needles of 13 mm in length, the cocktails 2 and two from group 3) had gained weight (mean gain:
were injected into the fat deposit following a multi- 1.1 kg) (Table III). Weight loss was 5.33 ⫾ 1.09 kg for
injection pattern. The amounts of cocktail injected group 1, 3.74 ⫾ 1.51 kg for group 2, and 2.82 ⫾ 1.43 kg
into each site ranged between 0.1 ml and 0.4 ml per for group 3.
application according to the individual needs of the
patient. The number of injections varied according Table II. ANOVA post-hoc pairwise comparisons.
to the size of the treatment area. Each session involved
up to 100 injections administered at various skin lev- D Paired
Group Before After (mean) SD p-values ANOVA
els with a separation distance of 2–4 cm.
Care was taken to respect the locations of the vas- Weight 1 66.07 60.70 5.33 1.22 0.00∗ 1–3∗
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cular and nervous systems to diminish the possibility (kg) 2 62.95 59.17 3.74 1.51 0.00∗ 1–2∗
of hematoma formation. 3 65.78 62.84 2.82 1.43 0.00∗ 2–3∗
BFP 1 29.43 24.76 4.66 1.09 0.00∗ 1–3∗
A questionnaire was given to the subjects to
2 28.40 25.13 3.28 1.20 0.00∗ 1–2∗
enquire about their experiences with mesotherapy. 3 30.41 28.26 2.16 0.86 0.00∗ 2–3∗
Results also were assessed subjectively by the patients Upper 1 90.60 85.82 4.78 1.21 0.00∗ 1–3∗
who completed a questionnaire that assessed the toler- belly 2 86.78 83.21 3.57 1.15 0.00∗ 1–2∗
ability and efficacy of the treatment. All of the women 3 88.07 85.53 2.54 0.98 0.00∗ 2–3∗
replied as to how much they were satisfied with the Lower 1 96.71 91.19 5.52 0.97 0.00∗
belly 2 88.93 85.22 3.70 1.56 0.00∗ 1–3∗
final results. A patient satisfaction score (A ⫽ not satis- 1–2∗
3 90.56 87.70 2.91 1.18 0.00∗
fied, B ⫽ somewhat satisfied, and C ⫽ highly satisfied) Waist 1 88.12 83.09 5.30 1.08 0.00∗ 1–3∗
was recorded after completion of treatment.The women 2 80.73 77.16 3.56 1.22 0.00∗ 1–2∗
were also asked whether they would recommend meso- 3 81.28 78.77 2.50 1.19 0.00∗ 2–3∗
therapy to others. At every visit any adverse effects Hip 1 105.36 97.70 7.66 1.18 0.00∗
2 100.06 95.48 4.57 1.73 0.00∗ 1–3∗
were recorded.
3 103.48 99.63 3.83 1.81 0.00∗ 1–2∗
Data are presented as means ⫾ SD. Pretreatment Right 1 61.25 57.27 3.98 0.62 0.00∗ 1–3∗
and post-treatment mean values for perimetric circum- thigh 2 55.80 52.92 2.88 1.01 0.00∗ 1–2∗
ferential thicknesses were calculated and then com- 3 59.60 57.56 2.04 0.84 0.00∗ 2–3∗
pared using the paired samples t-test. A value for Left 1 61.13 57.45 3.68 0.78 0.00∗ 1–3∗
p ⬍ 0.05 was considered statistically significant. The sta- thigh 2 55.61 52.81 2.79 0.98 0.00∗ 1–2∗
3 59.32 57.16 1.98 0.95 0.00∗ 2–3∗
tistical analysis was done by using ANOVA post-hoc
Right 1 50.41 46.91 3.50 0.62 0.00∗ 1–3∗
pairwise comparison and analysis of variance tests. calf 2 48.86 46.59 2.27 0.78 0.00∗ 1–2∗
3 50.61 49.07 1.54 0.56 0.00∗ 2–3∗
Left 1 50.48 46.82 3.65 0.73 0.00∗ 1–3∗
Results calf 2 48.68 46.25 2.44 0.92 0.00∗ 1–2∗
Seventy-two of all the patients (96%) included in our 3 50.67 49.28 1.40 0.78 0.00∗ 2–3∗
Right 1 39.60 36.63 2.97 0.77 0.00∗ 1–3∗
study showed a circumference loss, and the mean knee 2 38.41 36.38 2.03 0.61 0.00∗ 1–2∗
body circumference loss was statically significant for 3 40.09 38.94 1.14 0.58 0.00∗ 2–3∗
every measured body site, with p ⬍ 0.00. A body circum- Left 1 39.59 36.38 3.21 0.67 0.00∗ 1–3∗
ference increase was determined in only one patient knee 2 38.20 36.90 1.30 0.71 0.00∗ 1–2∗
in group 2 and two patients in group 3. The reason for 3 40.09 38.93 1.16 0.63 0.00∗ 2–3∗
this different response could be a lower sensibility of ∗Indicates significant differences.
the fat cells of these patients to these drug mixtures. D ⫽ difference; SD ⫽ standard deviation; BFP ⫽ body fat percentage.
The maximum mean circumference loss was obtained p ⬍ 0.05.
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Table III. Patient summary, overall treatment results.

Initials Group Age Weight (kg) – d bfp – d u belly – d l belly – d waist – d hip – d R thigh – d L thigh – d R calf – d L calf – d R knee – d L knee – d

I.A. 1 28.0 2.4 3.8 2.2 3.7 2.9 5.8 3.9 3.1 3.4 3.4 1.9 2.7
B.G. 1 29.0 4.6 4.3 4.2 5.6 4.6 7.6 3.6 2.8 2.2 3.5 2.8 2.3
F.T. 1 39.0 5.2 3.8 5.3 5.8 7.5 7.5 3.5 3.5 3.2 3.2 3.4 3.6
C.M. 1 46.0 4.9 6.8 3.3 4.3 4.6 6.4 3.2 3.2 2.6 4.5 3.3 3.6
A.V. 1 32.0 5.5 4.7 4.2 7.3 5.6 9.4 3.4 3.6 2.6 3.6 3.2 3.7
B.E. 1 34.0 4.5 4.3 6.4 6.8 6.6 10.4 3.2 3.0 2.6 3.8 4.4 2.7
G.A 1 35.0 5.2 6.4 5.3 4.8 4.6 9.7 4.3 4.3 4.6 2.5 2.6 3.5
A.B. 1 28.0 4.6 4.5 4.6 4.9 3.8 7.7 3.8 2.4 2.6 3.3 3.3 3.7
C.S. 1 27.0 8.5 5.7 6.3 6.3 5.4 7.1 4.2 3.7 4.2 4.7 2.7 4.3
A.K. 1 28.0 5.2 4.4 4.3 4.9 4.9 6.9 4.3 3.2 3.5 4.5 2.2 3.8
E.G. 1 33.0 5.6 3.6 3.8 5.6 5.2 7.2 3.3 2.7 3.7 3.9 2.5 3.5
S.K. 1 28.0 5.5 3.4 3.1 4.9 4.4 6.1 3.8 3.1 3.6 2.8 2.7 2.6
H.B. 1 40.0 5.2 4.6 5.2 5.1 5.1 8.3 3.6 4.2 3.9 3.3 3.3 2.6
Y.G. 1 36.0 6.3 3.5 3.8 4.1 3.6 7.6 5.2 4.2 4.2 3.5 3.2 1.6
M.D. 1 40.0 4.2 3.6 5.4 5.6 5.1 6.6 3.9 3.3 3.8 2.5 4.7 2.6
E.K. 1 28.0 5.4 3.8 2.3 3.8 3.5 6.7 4.4 3.2 3.4 3.4 2.8 2.8
A.B. 1 37.0 4.2 4.1 4.8 6.7 6.0 6.7 3.2 4.5 4.2 4.3 2.1 2.8
B.B. 1 30.0 5.3 5.3 5.3 6.6 6.1 8.3 4.4 3.2 3.6 3.8 2.5 3.5
A.E. 1 33.0 5.8 5.2 5.2 6.3 6.4 7.5 4.2 3.8 3.2 4.3 3.5 3.8
Y.T. 1 25.0 5.2 5.5 5.7 5.2 4.9 6.6 4.3 3.5 3.5 2.8 1.6 3.1
S.G. 1 52.0 6.2 4.6 6.2 5.7 4.6 9.6 4.4 5.1 3.2 2.9 2.4 2.4
K.O. 1 60.0 6.5 4.2 6.2 6.8 5.6 8.8 4.9 4.6 3.7 3.8 2.6 3.5
N.G. 1 34.0 4.8 4.5 5.3 5.5 4.3 7.4 3.1 3.4 3.9 3.1 3.5 3.7
S.K. 1 48.0 6.4 4.2 4.8 5.6 4.2 7.5 3.9 4.8 3.7 5.3 2.5 3.5
S.D. 1 35.0 6.1 7.8 6.4 6.2 6.3 8.1 5.4 5.5 4.4 4.6 4.5 4.4
N.K. 2 29.0 4.3 3.5 3.7 3.5 3.5 4.4 2.3 2.5 2.3 2.9 2.6 2.6
A.N. 2 36.0 3.2 2.9 4.2 4.8 3.9 6.3 3.8 3.2 2.3 2.1 2.1 1.8
M.A. 2 31.0 3.8 2.3 3.6 4.5 5.3 4.2 3.1 2.9 2.6 2.9 2.1 2.8
S.E. 2 39.0 3.9 4.4 4.1 5.5 4.1 4.6 3.3 2.6 2.2 2.4 2.5 2.5
M.O. 2 25.0 4.5 4.2 4.3 4.7 4.0 5.3 3.5 1.9 2.1 2.3 2.6 2.3
E.A. 2 25.0 3.3 3.5 4.2 4.3 3.2 5.0 3.3 2.3 3.6 3.5 2.3 2.5
F.E. 2 48.0 5.2 5.1 6.5 5.2 4.1 6.4 5.2 4.6 2.7 2.4 2.1 2.8
N.F. 2 26.0 4.3 3.5 4.8 4.3 4.1 4.4 3.3 3.4 2.2 3.1 2.7 2.7
N.Y. 2 36.0 4.2 5.5 3.3 4.4 4.6 5.2 3.4 3.2 3.2 3.4 2.6 3.3
S.O. 2 34.0 4.9 4.4 3.6 4.8 5.4 6.4 3.1 3.8 2.5 3.1 2.2 2.5
Y.O. 2 25.0 4.3 3.6 3.4 4.4 3.6 5.2 3.4 3.1 2.2 2.5 2.0 2.6
Y.A. 2 39.0 5.3 3.6 4.5 4.1 4.6 5.4 3.7 3.8 3.5 3.7 3.2 2.8
G.Y. 2 35.0 5.1 4.3 3.3 4.2 4.4 5.4 3.0 2.9 2.5 2.4 2.3 2.6
S.B. 2 35.0 6.8 4.1 2.9 3.8 4.4 5.9 3.3 3.2 2.3 2.9 2.2 2.6
S.S. 2 35.0 4.6 4.2 4.1 5.5 4.9 6.6 4.2 4.5 3.2 4.0 2.4 2.5
G.K. 2 54.0 2.3 2.5 2.6 2.7 3.2 2.4 1.2 2.3 2.9 2.8 1.5 1.2
Mesotherapeutic injections for body contouring

Y.G. 2 27.0 2.4 1.7 3.4 2.4 3.1 3.6 2.1 2.3 1.4 1.4 1.5 1.7

(Continued)
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146

Table III. (Continued)

Z. Kutlubay

Initials Group Age Weight (kg) – d bfp – d u belly – d l belly – d waist – d hip – d R thigh – d L thigh – d R calf – d L calf – d R knee – d L knee – d

Y.A. 2 34.0 3.6 2.9 3.6 4.9 3.1 4.4 2.7 2.9 2.9 2.6 2.3 1.4
J.B. 2 39.0 4.4 3.2 4.2 3.2 3.6 3.4 2.1 2.3 2.3 1.0 1.2 1.5
H.H. 2 40.0 3.2 2.8 3.5 4.0 3.4 5.2 3.4 3.2 2.2 2.6 2.0 1.5
A.H. 2 30.0 –0.8 0.3 0.2 –1.4 0.3 –1.9 0.3 –0.4 0.3 0.5 0.9 0.2
O.T. 2 29.0 1.3 0.9 1.8 1.2 0.8 3.1 1.6 1.7 1.1 0.8 0.9 0.5
P.A. 2 24.0 2.4 2.7 3.2 1.5 2.4 3.4 2.2 2.5 1.5 1.1 1.0 1.4
T.C. 2 23.0 2.7 2.6 2.1 2.3 2.1 4.7 2.1 2.5 1.1 1.6 1.2 1.5
T.K. 2 38.0 4.3 3.2 4.1 3.8 2.9 5.3 2.5 2.6 1.7 2.9 2.3 2.6
A.C. 3 27.0 3.1 2.4 2.3 2.5 3.2 4.4 2.2 2.8 1.4 1.2 1.7 0.9
M.S. 3 42.0 3.6 2.2 3.4 4.6 4.6 5.2 2.4 2.5 0.7 1.1 1.4 1.2
N.C. 3 36.0 3.6 3.2 3.5 3.1 2.2 3.6 2.7 2.2 1.9 1.2 0.9 1.3
S.E. 3 30.0 2.4 2.7 2.3 1.9 2.2 3.1 2.3 2.4 1.9 2.1 1.3 0.6
P.G. 3 24.0 3.2 2.3 2.8 3.0 3.4 4.6 1.6 1.5 1.1 1.1 1.0 1.2
T.A. 3 29.0 2.3 2.1 2.7 2.4 1.9 4.3 1.5 1.8 1.5 1.1 0.8 1.0
S.C. 3 36.0 3.3 3.1 2.4 3.5 3.4 4.9 3.4 2.4 1.7 2.9 2.4 1.3
T.K. 3 28.0 4.2 2.3 2.5 3.5 2.8 4.5 3.2 2.3 2.6 1.5 1.0 0.9
N.E. 3 25.0 4.7 2.9 3.6 4.0 3.2 5.9 2.3 3.0 2.2 2.5 1.4 1.5
D.M. 3 24.0 –1.1 0.5 0.3 –0.6 0.7 –1.4 0.3 –0.6 1.0 –1.1 0.2 –0.6
S.D. 3 27.0 2.9 2.3 2.7 3.6 2.6 3.1 1.4 1.2 1.2 1.7 1.2 0.9
F.K. 3 32.0 2.7 1.1 2.0 1.8 2.4 3.1 1.1 1.1 1.4 1.3 0.9 0.6
E.F. 3 46.0 3.1 2.6 2.6 2.0 2.3 3.6 1.2 1.3 1.6 0.9 0.8 0.6
E.K. 3 24.0 3.8 2.6 2.3 3.5 2.7 4.8 2.0 3.2 1.1 1.4 1.3 0.8
N.K. 3 36.0 –1.4 –0.8 –0.8 0.5 –1.6 –2.0 0.3 0.1 0.2 0.3 –0.2 0.4
S.C. 3 31.0 3.4 2.1 2.5 2.6 1.7 4.2 1.7 0.7 13.0 1.0 0.8 1.2
T.S. 3 30.0 0.9 2.5 3.6 3.1 2.4 4.6 3.2 2.5 2.1 2.3 1.8 2.1
U.Y. 3 20.0 3.2 2.5 2.5 3.2 3.4 4.4 2.7 2.2 1.5 1.3 1.4 1.0
Z.G. 3 27.0 3.1 2.4 2.7 4.0 3.3 4.1 3.3 2.7 1.9 2.2 2.6 2.5
S.Z. 3 32.0 2.4 1.5 2.3 3.0 2.2 4.5 1.7 1.8 2.8 2.0 1.1 1.6
N.V. 3 48.0 3.2 1.9 3.4 3.4 2.8 5.1 2.5 2.9 1.3 1.8 0.9 1.2
E.A. 3 32.0 3.1 2.8 2.2 3.5 1.8 4.0 1.7 1.5 1.4 1.4 1.2 1.4
H.F. 3 46.0 4.4 2.7 3.3 4.8 4.3 5.5 2.6 3.2 1.3 0.8 0.9 1.8
G.G. 3 23.0 3.2 1.6 3.2 2.3 2.5 3.6 2.2 2.6 1.4 1.5 0.8 1.5
A.A. 3 30.0 3.2 2.4 3.2 3.5 2.2 4.1 1.5 2.3 1.9 1.4 1.0 2.1

d ⫽ difference; bfp ⫽ body fat percentage; u ⫽ upper; l ⫽ lower; R ⫽ right; L ⫽ left.


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Figure 1. A patient from group 1 seen (A) before and (B) 1 month after the 15th session.
Of all the patients, only one (1.3%) in group 3
showed a BFP increase. Two patients gained weight yet
achieved some decrease in body fat. BFP losses were
statistically significant in all three groups, with p ⬍ 0.00.
The highest decrease was obtained as 4.66 ⫾ 1.09 in
group 1 (Table II).
Regarding the level of satisfaction with the effect
of mesotherapy, all of the patients answered with a
questionnaire. In terms of the subjective scales regard-
ing the effectiveness of mesotherapy, most of the patients
expressed positive thoughts about mesotherapy but
three patients (4%: one patient from group 2, two
patients from group 3) were not satisfied with the cos-
metic outcome of this therapy. Highly satisfied patients
were from group 1: 80% (20 of 25 patients). This was
63% (47 of 75 patients) when taken from all three groups
(Table IV). Almost all of the patients would recom-
mend this treatment to others as a body-contouring
procedure.
Cosmetic improvement was seen in every patient
(Figure 4): no irregularities or dimples were seen; no
serious side effects or complications were noted. Some
of the patients reported a little bit of pain, swelling
Mesotherapeutic injections for body contouring 147
and erythema, which typically lasted for 2–3 days.
Pain was typically minimal during and after the injec-
tions. The injected sites might bleed transiently and
exhibited signs of inflammation, which resolved within
several days. Seventeen of 75 patients (23%; 12
patients from group 2) had mild ecchymotic areas
situated primarily on the thighs which faded away
within 7–10 days. Nineteen of 25 patients (25% of all)
in group 1 complained of immediate burning (typically
lasting less than 30 minutes), transient urticaria and
variable degrees of pruritus. Postinflammatory hyper-
pigmentation, prolonged swelling, ulceration, and
hematoma formation were not determined in our
patients. No patients in any of the groups had sub-
cutaneous postinflammatory nodules at the injection
sites. During the study time, no re-enlargement of fat
deposits was reported (Table V).
Discussion
Mesotherapy qualifies at present as one of the ‘hot-
test’ topics in cosmetic medicine.
 148 Z. Kutlubay
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Figure 2. A patient from group 2 seen (A) before and (B) 1 month after the 15th session.
Mesotherapy is most commonly employed today
for the reduction of fat and cellulite. Specifically cre-
ated formulas are claimed to reduce fat content in
the cellulite, improve impaired circulation, and break
down damaged connective tissue, thereby smooth-
ing the skin surface. Such formulas are said also to
prevent cells from storing fat and help break down
existing fat cells apparently by inducing rupture and
cell death of adipocytes. Nevertheless, despite the
lack of supporting literature and despite the fact that
the use of mesotherapy solutions to induce local
lipolysis is based primarily on empirical observations
and long-term clinical use, mesotherapy techniques
are increasingly being applied to treat fat in the face,
neck, and elsewhere in the body and are the primary
application of mesotherapy in Turkey, as in other
countries (7,10).
Mesotherapists traditionally have resorted to polyp-
harmacy, combining several lipolytic stimulators with
the goal of enhancing lipolysis. There are a large num-
ber of protocols or treatment formulas used in meso-
therapy. Because each protocol differs from doctor to
doctor, it is not possible to test the effect of each for-
mula as a standard protocol (2). Currently, there is
no standardization of dosage and no treatment algo-
rithm to enable a prediction of how much tissue or fat
will be ‘dissolved’ with a specific solution in a defined
quantity injected at a specified subcutaneous tissue
depth. What components are combined and in what
proportions tends to be based on anecdotal reports or
the physician’s experience, rather than empirical data.
For this reason, in this study we aimed to find which
formula was the most effective. Of course it was not
possible to try all of the protocols. We chose the for-
mulas that are commonly used in our country and maybe
in the world. Isoproterenol, conjonctyl, yohimbine,
and aminophylline are all well-recognized lipolytic
stimulants for mesotherapy. Moreover, combinations
of lipolytic stimulators seem to produce greater stim-
ulation of lipolysis than each of the individual com-
ponents alone (10).
Traditional European mesotherapy does not incor-
porate PC and/or DC into its formulations. There is
not one standardized formulation for body contour-
ing and cellulite, a number of common ingredients are
advocated at training seminars and are readily available
over the internet.
It is possible that the mechanism of action involves
enhancing lipase activity and thereby lipolysis. When
body-contouring procedures are skillfully applied to
the appropriate patient, the results are pleasing to both
the physician and the patient. The promise of a simple,
permanent method of weight loss, spot weight reduction,
or cellulite improvement is obviously very appealing.
 Mesotherapeutic injections for body contouring 149
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Figure 3. A patient from group 3 seen (A) before and (B) 1 month after the last session.

With the rise in the number of overweight individu- membrane. It is a naturally occurring phospholipid
als in our society, it is likely that the demand will and has three important functions: (i) it emulsifies
increase for body-contouring procedures, including dietary fat; (ii) it is an essential component of the
mesotherapy. The use of mesotherapy for body con- apolipoproteins that regulate cholesterol metabolism;
touring in the English language medical literature is and (iii) it is an essential component of cell mem-
limited to a few clinical trials (1). branes. The mechanism by which injectable PC may
Lipolysis is regulated by α2 and β-adrenoreceptors result in decreased localized fat collections to improve
on the adipocyte cell surface: β-receptor activity increases the body contour is not well understood. One hypoth-
lipolysis; α2-receptor activity inhibits β-receptors. So, esis is that PC injected subcutaneously emulsifies fat,
β-adrenergic activation and α2-adrenergic inhibition allowing tissue lipases to hydrolyze fat, producing
increase lipolysis in fat cells (11). glycerol and free fatty acids (1,12).
PC, caffeine, organic silicium and buflomedil, Caffeine increases lipolysis, raises cyclic adenos-
L-carnitene, chophytol, and procaine were used in this ine monophosphate (cAMP) by inhibiting phos-
clinical trial because they were commonly used in phodiesterase (PDE), increasing catecholamine
mesotherapy by mesotherapists. release (epinephrine) by the sympathetic nervous
Phosphatidylcholine (PC) is a soybean lecithin extract system. A significant increase in free fatty acid
and the main phospholipid component of the cell (FFA) oxidation over physiologic levels is deter-
mined at rest and during exercise after ingestion
of caffeine (3,4,7).
Table IV. Patient satisfaction questionnaire results.
Conjoctyl (organic silicium, salicylate of monomethyl-
Average satisfaction score silanetriol) is an anti-oxidant effective drug. Silicon is
Somewhat Highly an element in the structure of elastic connective tissue.
Groups n Not satisfied satisfied satisfied It acts as a coenzyme in the synthesis of the macro-
molecules of the interstitial matrix. In the microcir-
Group 1 25 0 5 patients 20 patients
culation, it modifies the venous capillary and lymphatic
(20%) (80%)
Group 2 25 1 patients 8 patients 16 patients permeability, and in the adipose tissue it stimulates
(4%) (32%) (64%) the synthesis of the cAMP and the hydrolysis of trig-
Group 3 25 2 patients 12 patients 11 patients lycerides. Organic silicium increases collagen produc-
(8%) (48%) (44%) tion (3,4,6).
Total 75 3 patients 25 patients 47 patients
Buflomedil (Fonzylane) opens the precapillary sphinc-
(4%) (33%) (63%)
ter, improving microcirculation. It is considered to
 150 Z. Kutlubay
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Figure 4. (A) Before and (B) 1 month after the 15th session. Notice the improvement in cellulite appearance.
have a lipolytic or mesodrainage effect by inhibiting
the α-adrenoceptors (3,4).
l-Carnitene is an amino acid that constitutes an
essential cofactor in the metabolism of fatty acids act-
ing to diminish triglycerides and total cholesterol by
improving lipid metabolism. Lack of L-carnitine impedes
fat transport. Carnitine augments lipid oxidation. Car-
nitine increases the delivery rate of long-chain FFAs
into mitochondria for β-oxidation (7).
Chophytol (extract of artichoke, Cynara scolymus)
increases the volume of bile secreted. It increases the
antitoxic and glycogenic function of the liver. It also has
lipolytic, choloretic and anti-edema effects (3,4). It aug-
ments circulation and directly potentiates the release of
nitric oxide which is a potent vasorelaxant (7).
Procaine is best known for its anesthetic property.
Procaine is used in mesotherapy in the form of chlo-
rhydrate of procaine, 1–2%. It is anti-arrhythmic and
a vasodilator (3,4).
PC injections have recently become a popular treat-
ment for localized fat removal. A number of clinical
studies and recent presentations have demonstrated
localized fat loss in multiple anatomic sites after subcu-
taneous injections of a formula containing PC. PC is a
precursor to acetylcholine (8,13–16). Long-term fol-
low-up of patients treated with PC injections to reduce
local fat deposits indicate that the reduction of fat
deposits is permanent, provided weight gain is low or
none (13).
When used for body contouring, a ‘typical’ dosage
of PC of 100 mg per 5 ⫻ 5-cm area is recommended
and often three to six treatments are administered 2
weeks apart. Reported cosmetic results obtained with
Lipostabil are impressive (17). We also used Lipostabil
in group 1 patients and obtained the best results; 15
treatments, 250 mg per session, once a week. More-
over, there is no general agreement on its mode of
action in cosmetic applications even though it is
thought to work as a detergent causing nonspecific
fat-cell membrane lysis (1,5). It is theorized that the
reduction of subcutaneous fat likely follows inflamma-
tion-mediated necrosis and resorption (15,18). Recent
data suggest that cell lysis may be due to the action of
DC, a natural detergent used in these formulations to
keep PC soluble in water. Irrespectively, the chemical
effects of PC/DC, either through direct detergent
effects upon the adipocyte cell membrane or an indi-
rect response following inflammatory-cell-mediated
chemotaxis to the area, result in an increase in acute
and chronic inflammation within the septae and lob-
ules of the subcutaneous fat. Eventually, the inflam-
matory response may abate with ingrowth of fibrocytes
and collagen production (18–20). Fibroplasia and an
associated reduction in adipocyte number and volume
could contribute to the tightening and possible retrac-
tion of skin. In Brazil, PC has been used extensively
as an off-label cosmetic treatment of unwanted fat
deposits (5).

Table V. Side effects and complications.
Burning
Ecchymosis pruritus Pain Hyperpigmentation
Group 1 3 19 1 0
Group 2 12 0 0 0 0
Group 3 2 0 0 0
Total 17 (23%) 19 (25%) 1 (1.3%) 0 0
In an open-label clinical trial by Rittes (13), 50
patients were injected subcutaneously in the trunk,
neck, and extremities with 5 ml Lipostabil (50 mg/ml
PC) distributed over an 80-cm2 surface area. Thirty-
five of 50 patients received four treatments, the rest
had one to two treatments, all sessions were spaced
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15 days apart. Improvement occurs in ‘all’ patients
(no objective data); at the 4-year follow-up no recur-
rence was determined in treated areas unless weight
was gained by patients.
In a study reported by Moy, the trunk, chin, and
extremities were injected with 0.5 ml/cm2 of a PC for-
mulation (50 mg/ml) for two treatments spaced monthly.
An average decrease of 7.45 mm was measured in
subcutaneous fat thickness 1 month after the last
treatment (8).
In a double-blinded clinical trial by Asaadi et al.
For personal use only.
(21), 100 patients were divided evenly into five treat-
ment groups; each received either a vasodilator (buflo-
medil), lipolytic (compounded PC), homeopathic agents
(carnitine and Melilotus), an equal combination of all
medications, or placebo (normal saline). Each patient
had 0.1–0.2 ml of solution injected every 1–2 cm into
the thighs, waist and flank weekly for 5 weeks, then
monthly for a maximum of 5 months. Eighteen of 20
patients in the combination group versus 14 of 20
patients in the PC group experienced at least a 2.5-cm
decrease in thigh circumference.The mean waist circum-
ference decreased 4.2 cm in the combination group.
No significant decrease in circumference was deter-
mined in the vasodilator, homeopathic, or saline groups.
No weight change was experienced by any patients.
In another clinical trial by Rullan and Hexsel, 50
patients received one to three injections of a ‘cocktail’
(PC, aminophylline, carnitine, and lidocaine) in the jowls
and submental region every 2–4 weeks. No more than
0.2 m was delivered subcutaneously per 1 cm. All
patients had some degree of improvement: 50% had
‘minor improvement’, 40% had ‘significant improve-
ment’, and 10% had ‘dramatic improvement’; 85%
of patients surveyed were satisfied and desired more
treatments. Subcutaneous nodules developed in ‘most
patients’ and all resolved spontaneously (8). We did
not determine any subcutaneous nodules or granu-
lomas in group 1 patients injected with the formula
containing PC or in those of the other two groups
(Table V).
A study reported by Duncan and Hasengschwandt-
ner (19) included the outcome of a series of 43 patients
treated with up to 100 ml of PC (maximum 2.5 g)
Mesotherapeutic injections for body contouring 151
Ulceration
Hematoma nodule Infection Necrosis Irregularity
0 0 0 0 0
0 0 0 0
0 0 0 0 0
0 0 0 0
per session every 4–8 weeks for up to four treatments.
Multiple anatomic sites (including chin, abdomen,
buttocks, thighs) were injected subcutaneously with
0.4 ml PC distributed every 1–1.5 cm. ‘Dramatic
improvement’ was reported in 13 patients; 29 patients
had ‘mild to moderate improvement’; one patient
was a nonresponder. In our study, we obtained high
satisfaction in 80% of patients injected with a PC
cocktail.
The pharmacologically active agents cited in the
literature act on the adipose tissue, connective tissue,
or microcirculation, and can be used transdermally.
In vitro studies show that methylxanthines (theo-
phylline, aminophylline, caffeine) stimulate lipolysis
and a reduction in the size of adipocytes through the
inhibition of phosphodiesterase and an increase in
cAMP (4,8).
In a study by Park et al. (2) the authors injected a
mixed solution (i.e. aminophylline, buflomedil and
lidocaine) into the superficial dermis of the medial
aspect of one thigh weekly and no treatment was given
to the other thigh. There was no body contouring
observed in this study. There were no statistically sig-
nificant changes in thigh girth. In our study, all the
results (including weight, BFP and body circumfer-
ences) in group 3 (containing buflomedil) are the low-
est among the three groups; but all the values were
statistically significant (Tables II and III).
Two plastic surgeons performed a clinical study
to evaluate the use of mesotherapy for body contour-
ing. Forty patients were enrolled in a prospective
study; a single-body region was treated by mesother-
apy on a weekly basis for 5 weeks, followed by monthly
maintenance therapy. The patients were separated
into four groups: group I (n ⫽ 10) received mesother-
apy treatments unilaterally; group II (n ⫽ 10) received
treatments bilaterally; group III (n ⫽ 10) received
mesotherapy in association with dietary modification
and exercise; and group IV (n ⫽ 10) received saline
placebo injections. Circumference measurements dec-
reased in the majority of treated patients. The average
decrease in circumference was 2.6 cm at the waist
and 1.8 cm at the thigh. When evaluating all three
groups in our study, the decrease in circumference
at the waist was 3.78 cm in our patients. No major
complications occurred, but several minor complica-
tions were observed (1).
A double-blinded clinical trial evaluating ‘mesoplasty’,
which was recently presented at the American Society
of Plastic Surgery Annual Meeting, demonstrated
 152 Z. Kutlubay
significant waist and thigh reductions restricted to
patients receiving subcutaneous injections of a PC
formulation; the vasodilator (buflomedil) and homeo-
pathic (carnitine and Melilotus) treatments did not
produce any effect (7).
Localized mesotherapy complications include aller-
gic reactions, urticaria, lichenoid drug eruptions, pso-
riasis, hematoma, ulceration, necrosis, and various
bacterial infections. It is claimed that most adverse reac-
tions associated with mesotherapy lipolysis are mild and
transient, and supporters of the procedure consider it
a safer alternative to liposuction (4,5,8).
Patients in the current study tolerated the treatment
sessions without difficulty and serious adverse effects
that could interrupt patient attendance were not seen.
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Patients generally feel only slight pain during the pro-
cedure. Only one (1.3%) of our patients in group 1
complained of severe pain during the procedure. Park
et al. (2) reported that most of their patients (56%)
experienced severe pain during the mesotherapy. It may
be due to the effect of different anesthetic drugs or
technique. We added procaine to the mesotherapy
cocktails, whereas they had added lidocaine to the solu-
tion. We observed bruising and ecchymotic areas in 12
patients from group 2 (16%) (caffeine cocktail). Simi-
larly, pruritus and burning were only determined in 19
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group 1 patients (25%) (Table V). All of them had to
take oral antihistamines. Most patients (96%) con-
cluded that, overall, the treatments were effective.
Information on mesotherapy in the English lan-
guage medical literature is scant. There are few publi-
cations regarding its safety, efficacy, and mechanism of
action. Information on formulations, technique, dos-
ages, treatment protocols (including dose/injection,
technique/injection, and interval times), and toxicology
is not available and scientific literature describing the
use of specific substances is limited (1,22). Although
the FDA has approved most of the ingredients used in
mesotherapy, its constituents are being utilized for
unapproved indications and are being administered in
a manner whose efficacy, safety, and pharmacokinetics
are unknown (5,7).
This study demonstrates the effectiveness of meso-
therapy for body contouring and slimming. Moreover,
there are many reports showing unexpected infections
or adverse reactions to mesotherapy (23). More clini-
cal trials will be needed to demonstrate the effective-
ness of mesotherapy.
A loss in circumference measurement was seen in
most of the patients (96%). When three groups were
compared with regard to mean body circumference
loss, patients in group 1 showed the best results. The
difference in mean grades before and after treatment
was statistically significant, with p ⬍ 0.00. We found
that weight, BFP and body circumference losses were
interrelated.
We performed circumference measurements of
the selected body sites and used them to determine
improvements in body contours. On the other hand,
we believe that ultrasound and magnetic resonance
imaging that allow evaluation of subcutaneous tissue
should be added to these methods for more accurate
assessment. The potential limitations of the present
study are the lack of biopsies showing fat necrosis and
the lack of more objective means of assessing treat-
ment success.
The majority of patients experienced minimal dis-
comfort with mesotherapy. Some patients saw results
after one treatment session while others may require five
or more treatments to begin to see results. Often the
patient’s clothing became looser and friends and family
told the patient they looked thinner and smoother.
When examining statistical analysis of t-tests for
paired samples within each group before and after treat-
ment, all the results were determined as statistically
significant (p ⬍ 0.00) (Table II). When we look at anal-
ysis of co-variance values (all statistical effects entered
simultaneously) among the groups, group 1 has the
most effective results. Group 1 is statistically more sig-
nificant than both the other two groups when evalu-
ating all the parameters including weight, BFP and
circumferential measurements of 10 body sites. So
we can claim that the mesotherapy cocktail contain-
ing PC/DC is more effective than those containing
caffeine and traditional mesotherapy formulas. Group
2 is also statistically more efficient than group 3, except
lower belly and hip.
Such researches like our study will help us to find
the most effective mesotherapy formulas for body con-
touring and melting away fat. Mesotherapy for fat
reduction is more about losing inches than losing large
amounts of weight. Products whose mechanism of action
is well understood and whose adverse effects and doses
are well studied should be chosen.
Conclusion
Our ultimate goal as doctors will always be to provide
safe, proven methods of medical care, guaranteeing the
best possible result for our patients with the minimum
amount of morbidity. It is important to assess the ben-
efits, safety, experience, and standardization of meso-
therapy, and as a method of body contouring; more
studies are necessary before mesotherapy can be advo-
cated as a safe and effective treatment. This painless
approach to body contouring will always be appealing
to many, but without scientific evidence to verify meso-
therapy’s usefulness, mesotherapists must be aware of
the risks of the treatments and the lack of FDA approval
of the ingredients used in the injections (5).
Despite a number of anecdotal reports and exper-
imental data suggesting that components of traditional
mesotherapy formulations may be effective, there are
presently few peer-reviewed clinical trials that critically
evaluate the efficacy of these localized injections for
medical or cosmetic applications.
Mesotherapy treatments have been performed
through out Turkey for 10 – 15 years. The Turkish

fascination with mesotherapy has been limited to its
aesthetic applications, which are becoming increasingly
popular for body contouring and spot weight loss.
The shortness of scientific validation is not proof
that mesotherapy does not work. Even if there are some
reports showing that mesotherapy is not effective (2,24),
this study declares that all of the three different meso-
therapy cocktails are beneficial and statistically effective
for controlling local obesity and for body contouring.
The formula containing PC/DC injected into the
patients of group 1 is the most effective one. Meso-
therapy is recommended for body contouring because
most patients (96%) are happy with mesotherapy
results, and its side effects are minimal and negligible.
For those patients seeking fat loss and body con-
J Cosmet Laser Ther Downloaded from informahealthcare.com by University of Limerick on 05/22/13
touring, mesotherapy is a good treatment for losing
localized fat.
Declaration of interest: The author has no finan-
cial interest in any of the products, or drugs men-
tioned in this article.
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