February 14,2003

Origin of the term

The ‘mesoderm’ is the term used in biology to describe a ‘middle layer’ of cells and tissues in the developing embryo. From this layer of cells develops the deeper layers of the skin, subcutaneous tissue which is just beneath the skin, fatty tissues, tendonous tissues, bony tissues, etc.

Therapy on this ‘middle layer’ is thus ‘mesotherapy‘.

As an ancillary piece of information, the other layers of the embryo are the ectoderm and endoderm .The ‘ectoderm’ forms, among other tissues, the brain and outer layer of the skin. The endoderm forms amoung other tissues, the linings of the intestines, bladder and so forth.

Treating the Mesoderm

As a concept, treating the ‘middle layer’ as a method of practice originated in France in the early 1950s by Dr.M. Pistor. As a method of practice, treatments consisting of multiple injections into the mesodermal areas, using a combination of medications or compounds, for various conditions, using needles was a new idea at that time. The method of practice has evolved and become more elaborate with different nuances such as smaller gauge needles and injection ‘guns’ for delivery of medications and compounds. Most of Europe has practitioners who are ‘mesotherapists’. Their number is currently estimated in the tens of thousands.

My Doctor Uses Needles !

For many years physicians and surgeons in North America, have been injecting medications into the mesodermal tissues, but not as a formalized method of practice. As an example, in the USA, medical and surgical practitioners administer steroid injections into tendons, cysts, muscles, fascia, etc. Also, in today’s day and age, the use of very fine needles such as 30 and 27 gauge needles is not unusual. If you look for them, there are physicians and surgeons in our hemisphere who of course use techniques that treat the mesodermal tissues. Which came first – mesotherapy or your doctor using needles to treat you injured shoulder ??? As far as I can discern, Mesotherapists use more medications, more mixtures of medications, more needles, for more reasons (indications), more frequently, and have incorporated the techniques of mesotheapy into their practice. They ‘think’ meso tissues – and meso methods.

Method of Treatment

Mesotherapy, as a method, involves
– The use of frequent treatments.
– The individual patient understands and accepts these frequent treatments.
– Injections are the method of delivery and changing of the ‘meso tissues’.
– The materials that are injected are of a wider variety than is the ‘norm’ as practiced in the US.
– Usually more than one compound or medication will be injected during a treatment.
– The concentrations of injected materials are tailored and titrated depending on the diagnosis, area to be treated, severity of problem and so forth.
– Currently, the use of fine bore needles is a part of mesotherapy.
– An injection ‘gun’ may be used as part of ‘modern day’ mesotherapy.
– Some methods use multiple needles at one time.

The use of a fine needle to administer the correct compound to the correct place at the correct concentration for the correct diagnosis at the correct intervals is key to ‘good’ practice.

Problems and Complications

What can happen if all of the above, or even some of the above, are not appropriately practiced? (This is not to say that even if all is appropriately done, that problems could not occur !)

As a learned plastic surgeon colleague from Milan has stated – “given the.. abuse of this otherwise fine discipline, I see “holes”, “irregularities” and areas of fibrosis in many patients who have been abused by these “practitioners” for years, with the “mirage” of avoiding liposuction (which they do not know how to perform ..) I suspect this is more of a fault to attribute to the doctor, rather than the technique.”

Does It ‘Hurt’?

Some say that treatments with multiple needles do not ‘hurt’. As a matter of fact, I never met a needle that rarely pinched and have never met a needle that never pinched ! Needles pinch. Needles hurt – sometimes certainly ! (‘ok’ – if you are ‘out cold’- have ‘nerve problems’, etc., the above does not pertain !)

Currently mesotherapy is practiced for the following general categories of conditions.

General medicine

Sports medicine – musculoskeletal problems – arthritis

Musculoskeletal conditions – mesotherapy has usefulness in conditions such as tendonitis. Doctors in the USA treat people with tendonitis using steroid injections as the ‘mesotherapists’ in Europe treat the condition. The method of delivery and the medications used may be somewhat different.

Aesthetic – cosmetic conditions
for problems such as


Cellulite ‘mesotherapy treatments’ can be used alone or with other methods. Combinations of mesotherapy with other methods of treatment such as external ultrasound, canula dissection, tumescence, etc., seem to have significant potential.

Localized fatty tissue and Lipocontouring

A significant volume of fat can not be removed, at least not from what I have seen. Small areas could be treated. I do not see it as a substitute for liposuction – at least at this point in time. This method should not be termed meso-liposuction as there is no suction.

Sagging tissues of the face and elsewhere (meso lift)

Injection of medications, vitamins, minerals, etc. beneath the skin can be associated with tightening of the area. To this point data is inconclusive as to whether injections alone – will be effective in lifting and tightening. When combined with other methods such as ultrasound, and various forms of subcutaneous dissection (i.e. surgery), mesotherapy injections may add to our abilities to sculpt faces.

Is it effective?

Used correctly and as noted above, mesotherapy certainly has applications at its current state of development. Once more attention is paid to the field of mesotherapy, there should be rapid development. This discipline will meld with other disciplines. Our goal is to provide longer lasting results with less invasive procedures, and mesotherapy can probably help.

An Update (10-2004)

Staying up to date in plastic Surgery requires constant vigilance.

‘New’ Developments

As has been said many times – What is new is not always new !!

During February of 2003, comments about mesotherapy were made to WOKR Channel 10, TV Rochester, NY. During this interview, the history of mesotherapy was reviewed. The fact that MESOTHERAPY was about to become ‘new’ and ‘big’ in the United States was discussed. Prior to the TV station’s awareness, an opinion had been presented on the web for months. Actually, Mesotherapy began for all intents in 1952 in France. We have reviewed the history of mesotherapy which is available for your review on another page. Please see http://www.capuanousa.com/plastic/meso/index.htm . So ‘what’s new’, isn’t really ‘new’.

During 2004, Mesotherapy has indeed become ‘big’ and ‘new’ in the USA. As fortune would have it, the French Physician who developed the technique recently passed away – not to see the burgeoning of his technique in the ‘States’ While mesotherapy in many forms have been used in our office for years, mesotherapy for fat removal is now being offered.

Dr. Capuano, along with is prior methods and experience using mesotherapy, has attended current concept teaching conferences on newer methods in mesotherapy. Physicians from South Beach, Paris and New York, have lectured extensively re the techniques that they use. During the 2004 meeting of the American Society of Plastic Surgery, in Philadelphia, Mesotherapy was a highlight of the meeting. Dr. Capuano Attended the meeting and the meeting was review by The Cosmetic Surgery News (see http://www.cosmeticsurgery-news.com/article2272.html).
From the scientific point of view, mesotherapy has been, and is a logical method of improving various conditions, including ‘fat melting’ for local fat deposits.

What is important is to realize, is the limitations of the procedure.

Removal of large volumes of fat is not currently possible.

Further the individual must not think that overeating can accompany the use of mesotherapy. As the ‘South Beach’ mesotherapist says, ‘You can never take it off as fast as they can eat it on’ !

The individual seeking therapy must accept the fact that some of the compounds, elements, mixtures, etc are ‘off label use’ or not approved in the United States for therapy. They may or may not be OK in other countries such as France, Italy and South America, but here in the States, approval by the FDA may not be forthcoming. The patient should not under go the treatment unless they agree to the off label use of what is injected.

Areas of Treatment may include Hips – Abdomen – Thighs – Neck – Lids – Arms, Etc

Treatments are not a one time situation. Four to ten, and sometimes more, treatments may be needed. Depending on the area for treatment, the cost on average may be 200 USD to 600 USD per session, (as of 10-2004).

Finally, as was noted previously, by my learned Plastic Surgical Colleague from Milan, used correctly, mesotherapy can be an excellent tool in body contouring.