Mesotherapy, commonly known as “biorejuvenation” or “biorevitalization”, is a technique used to rejuvenate the skin by means of a transdermal injection of a multivitamin solution and natural plant extracts that are thought to improve the signs of skin aging.
This prospective study aimed to evaluate the clinical effect of mesotherapy applied to periorbital wrinkles and to quantitatively evaluate histological changes in the skin occurring in response to the same treatment.
Six volunteers with Fitzpatrick skin types III or IV and Glogau class I–III wrinkles were subjected to a three-month course of mesotherapy injections in the periocular area (six sessions administered at two-week intervals). Standard photographs and skin biopsies were obtained from the treatment area at baseline, at the end of treatment, and at three months post-treatment. Quantitative evaluation of collagen types I, III, and VII, newly synthesized collagen, total elastin, and tropoelastin was performed using a computerized morphometric analysis.
The clinical evaluation of volunteers at baseline, end of treatment, and three months post-treatment revealed no significant differences. Histological and immunostaining analysis of collagen types I, III, and VII, newly synthesized collagen, total elastin, and tropoelastin showed no statistically significant changes (P > 0.05) after mesotherapy injection.
The present study indicates that mesotherapy for skin rejuvenation does not result in statistically significant histological changes or clinical improvement.
Aging is a complex, multifactorial process that affects every organ in the body, including the skin.1,2 Clinically, aged skin is characterized as thin, dry, and pale, with noticeable wrinkles and decreased elasticity.3,4 The histological changes associated with aging in skin include the accumulation of elastotic material in the papillary and mid-dermis, a process known as solar elastosis, and quantitative changes in collagen, which are reflected in a decline in biosynthesis and content.4
Mesotherapy, initially described in France by Michel Pistor,5 is one of the modalities recently used to rejuvenate and tone the skin.6,7 It involves the non-invasive transdermal injection of vitamins, enzymes, hormones, hyaluronic acid, and natural plant extracts into the skin to stimulate the biosynthetic ability of fibroblasts and facilitate interaction between cells and is intended to increase collagen and elastin production.8,9 Different injection techniques can be used in mesotherapy: (i) the intra-epidermal technique; (ii) the papular technique, in which reagents are injected into the dermo–epidermal junction; (ii) the nappage method, in which injections penetrate to a depth of 2–4 mm and are delivered at an angle of 30–60°; and (iv) point-by-point injection into the deep dermis.10,11
Over the past few years, the use of mesotherapy for skin rejuvenation has increased rapidly at a relatively high financial cost to patients. As no in-depth, evidence-based studies have explored the safety or efficacy of mesotherapy, questions remain about the scientific validity of this popular approach. The purpose of this study was to evaluate the clinical effects of this treatment and to objectively quantify the corresponding histological changes associated with mesotherapy injection as a non-invasive method of skin rejuvenation.
Six female volunteers with Fitzpatrick skin types III or IV and Glogau class I–III wrinkles12 were subjected to three months of treatment with mesotherapy injection (delivered in six sessions held at 2-week intervals). The volunteers were recruited from the dermatology outpatient clinic at Al-Minya University Hospital, Al-Minya, Egypt, which they had attended for treatment of periorbital wrinkles. Their mean age was 43.1 ± 4.7 years (range: 37–49 years). The treatment and study details were fully explained to the subjects, all of whom signed informed consent forms pertaining to treatment and participation in the study, which included consent to photography and skin biopsy before treatment, at three months (end of treatment), and at six months after the start of treatment (three months post-treatment).
Mesotherapy injection is a minimally painful procedure and requires no anesthesia. Before treatment, the volunteer was positioned for treatment and the periorbital area on both sides of the face (treatment area) was marked. The sterile solutions used for injection were composed of a cocktail of a multivitamin solution and non-cross-linked, high-viscosity hyaluronic acid, provided in two separate vials in a packaged kit (Revitacare®, Bio-Revitalisation; Laboratoire Revitacare, Saint Ouen l’Aumône, France). The first vial contained 4 ml of non-cross-linked hyaluronic acid at 1% biotechnological origin and water for injectable preparation. The second vial contained 10 ml of a multivitamin solution of retinol 10,000 IU (5.5 mg), thiamine 4 mg, riboflavin 0.6 mg, nicotinamide 20 mg, dexpanthenol 8 mg, pyridoxine 4 mg, ascorbic acid 100 mg, ergocalciferol 2000 IU (2 mg), tocopherol 4 mg, Solutol® HS 15.52 mg, and water for injectable preparation. Materials were stored in a refrigerator, mixed immediately before injection, and transferred to 1-ml syringes to accommodate the high viscosity of the hyaluronic acid. For each volunteer, the injection material was prepared and mixed as a diluted suspension of multivitamin solution for injection and non-cross-linked, high-viscosity hyaluronic acid at a ratio of 9 : 1.
The injection process was performed using a meso-system gun [Anti-Aging Medical Systems (AAMS), Montrodat, France] controlled by a microprocessor with eight different injection programs. The gun maintained automatic control of the syringe and allowed the depth and dose of the injection to be adjusted electronically. The gun was positioned at an angle of 60° to the surface of the skin. In each injection, approximately 0.01 ml of solution was injected into the skin at a depth of 2 mm using the nappage technique in a horizontal direction; the total amount of solution injected per session on both sides of the face was 2 ml.
The clinical status of the skin in terms of wrinkles, tautness, and texture was evaluated and rated by the volunteer, two dermatologists, and two independent observers before treatment and at three and six months after the start of treatment. Rating was based on a 5-point scale on which improvement was rated as none (0%), mild (1–25%), moderate (26–50%), good (51–75%), or very good (76–100%).
Punch biopsies (3 mm) were obtained from the facial skin (treatment site) at baseline, at the end of treatment, and at three months post-treatment. Biopsies obtained after treatment were taken from a site near to that of the pretreatment biopsies. Tissues were fixed in 10% buffered formalin, embedded in paraffin, and sliced into sections 5 μm thick. All histological and immunostaining evaluations were carried out in the Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, USA.