Is Mesotherapy Effective in the Treatment of Lower Eyelid Fat
Herniation?
A. Peter Salas, MD, Mokhtar Asaadi, MD, and Bijan Motamedi, MD
Mesotherapy was first introduced in France by Dr. Michel Pistor in 1952. Although it has
enjoyed wide recognition throughout the world, it has only recently been available in the
United States. Mesotherapy involves a series of microinjections of medications into
various layers of the skin to achieve a desired result. We prospectively compared
patients undergoing mesotherapy with traditional blepharoplasty in order to determine
the role mesotherapy in the treatment of lower eyelid fat herniation.
Methods: We enrolled 60 patients in a prospective study comparing mesotherapy and
traditional blepharoplasty in the treatment of lower eyelid fat herniation. Thirty patients
were enrolled in each of 2 group. Seven patients in the mesotherapy group had to be
excluded since they either did not complete their course of treatment or opted to
undergo traditional blepharoplasty during the study period. An additional 2 patients were
lost to follow-up during the study period. Three patients in the traditional blepharoplasty
group were excluded since they did not complete the procedure by the conclusion of the
study. A fourth patient had to undergo additional eyelid surgery and was therefore also
excluded. The mesotherapy patients received 3 to 4 treatments to the lower eyelids
spaced 2 to 5 weeks apart. Treatment involved 3 injections into each lower eyelid
corresponding to the 3 pockets of fat. All blepharoplasty patients underwent a single
procedure during the study period.
Results: All patients were followed for a minimum of six months. The patients were
evaluated by a physician and given a patient satisfaction questionnaire. Patient
photographs were also evaluated by a physician who was not involved with any of the
treatments. Ninety percent of patients undergoing mesotherapy reported improvement in
their lower eyelids. This was significantly higher than clinical and photographic
evaluation by a physician (62% and 76% respectively). Fifty seven percent of patients
rated their improvement as 8/10 or better. These results were similar to that observed
clinically and by photographic evaluation (62% and 67% respectively. All patients
undergoing traditional blepharoplasty reported improvement in their lower eyelids. Eighty
five percent of the blepharoplasty group rated their improvement as 8/10 or better. No
major complications were observed in either group. Minor complications included
swelling, bruising, and pain in both groups. Some of the patients undergoing
mesotherapy also developed transient nodularity within the lower eyelid fat which
resolved spontaneously.
Conclusion: Mesotherapy has become a popular method of localized fat reduction,
especially among non-surgical practitioners. It has also garnered a great deal of media
attention and has been advertised as the alternative to surgery. This has left many
plastic surgeons confused about the role of mesotherapy in their practice. This
preliminary study demonstrates the superiority of traditional blepharoplasty to
mesotherapy in the treatment of lower eyelid fat herniation. However, in carefully
selected patients, satisfactory results can be achieved with mesotherapy alone. In
patients with mild to moderate fat herniation and minimal or no excess skin,
mesotherapy appeared to be effective in improving the appearance of the lower eyelids.
In addition, patients who do not want to undergo surgery may find mesotherapy to be a
good alternative. Plastic surgery patients often expect immediate results. In our study,
this led to attrition of some patients in the mesotherapy treatment group. With better
understanding of the effective formulations and the mechanism by which mesotherapy
reduces fat, better results may be achievable in the future.