Acne & Acne Scar Mesotherapy

What Is Acne & Acne Scar Mesotherapy?

Acne and acne scar mesotherapy is the general name for delivering active ingredients into the skin through many small injections for acne-related skin problems. In mesotherapy, active ingredients are injected into the skin and the tissue beneath it. However, there is no single standard for which substance to use, at what depth or at what intervals.

Experts acknowledge this uncertainty too. An international consensus statement on mesotherapy stresses that there is no internationally recognised, evidence-based standard for its various clinical uses, and that high-quality research is still needed. According to publications on its complications, the method is considered relatively safe. However, because it is used for so many purposes and lacks standards, various unwanted reactions can occur.

The two topics in the title need to be kept apart. Active acne is a skin disease; acne scars are the permanent tissue change that this disease leaves behind. Studies on the psychological and social effects of acne scars also stress that scars are a separate condition from active acne and need their own clinical approach, different from those used for active acne.

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Active Acne

Active acne, meaning ongoing spots and inflamed lesions, is a skin disease whose treatment is set out in clinical guidelines. In this situation, the first step is standard medical treatment, not mesotherapy. The American Academy of Dermatology guideline makes strong recommendations for benzoyl peroxide, retinoids applied to the skin (topical retinoids), topical antibiotics and oral doxycycline.

The same guideline strongly recommends oral isotretinoin for acne that is severe, places a psychological and social burden on the person, leaves scars or does not respond to standard treatment. Hormonal treatments and some newer medicines applied to the skin are among its conditional recommendations. Steroid (corticosteroid) injections into large lesions are also included as a good practice statement; however, this is part of drug treatment, not mesotherapy. Mesotherapy is not among the recommendations in the guideline summary. The current version of the European guideline also focuses on questions about drug treatment, such as isotretinoin, the duration of systemic antibiotic use and hormonal treatments.

Data on mesotherapy for active acne are limited. In a study of 108 patients with moderate to severe acne, mesotherapy containing glycyrrhizin, added to clindamycin applied to the skin, gave better results than clindamycin alone. However, this is a single study, and the only comparison was with topical clindamycin. It was not compared with treatments that combine more than one mechanism of action, which the guideline recommends as good practice. In a randomised trial (in which participants were randomly assigned to groups) of women with oily skin, not patients with acne, microneedle mesotherapy reduced oil production in the T-zone only after six treatments, and in the same area colonisation by an acne-related bacterium increased.

Taken together, these data do not define mesotherapy as an option that replaces guideline-based treatment for active acne. New scars can keep forming while acne continues, and the importance of early, effective treatment in reducing the risk of scarring is emphasised. So the order is: first bring the disease under control, then assess the scars.

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Acne Scars

Acne scars are a permanent tissue change left in the skin after inflammation has settled, and they are a separate issue from active acne. Acne scars fall into three main groups: atrophic (pitted) scars, raised hypertrophic scars, and keloids. Atrophic scars are further classified as narrow, deep ice pick scars; rolling scars with rounded edges; and boxcar scars with sharp edges.

This distinction is not just a classification; it is the starting point for planning. Identifying the scar subtype and the assessment scales to use allows the approach to be tailored to the individual. Scars in the tissue and marks that leave discolouration are also dealt with as separate topics. Publications state clearly that scars can form even with effective acne treatment.

Acne scars are common. In an analysis combining data from many studies (a meta-analysis) and covering a total of 24,649 patients with acne, the frequency of acne scars was calculated at 47%. Male sex, a family history of acne and the severity of acne were identified as risk factors for scarring. The researchers concluded that attention and effective treatment early in the course of acne are important for reducing scarring. These figures are a population average; they do not show any one person’s risk of scarring.

In practice, this means that the type of scar is identified at a consultation. A narrow, deep scar, a wide, rolling scar and a raised scar are not the same problem, and this also determines which approaches can and cannot be discussed.

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Post-Acne Redness and Dark Marks Differ from Tissue Scars

Not every change left after acne is a pit or a raised area. Some remain as redness or dark marks, and these are separate issues. Post-acne redness consists of enlarged small blood vessels (broken veins) and red lesions left behind after acne inflammation. According to studies on this subject, some lesions can fade over time; however, there is no treatment accepted as the standard (a ‘gold standard’).

Light- and laser-based devices have been used most often in studies. Some medicines applied to the skin have been found promising, but the need for more randomised trials has been stressed. The most concrete data on mesotherapy also relate to this area, but they come from small studies. In a single-centre, randomised split-face study (one side of the face compared with the other) using non-cross-linked hyaluronic acid, redness scores fell significantly compared with the control side in the 23 patients who completed three sessions. In another study, tranexamic acid was applied to one half of the face, the other half was left as a control, and 15 patients completed the study; a significant reduction in lesions was reported only on the treated side. The researchers noted that more studies are needed because the number of patients was small.

Dark marks form through a different mechanism. According to an expert paper on acne-related post-inflammatory hyperpigmentation (darkening of the skin after inflammation), these marks can develop even in mild to moderate acne, without obvious signs of inflammation. They occur mainly in people with darker skin (darker skin phototypes), and ultraviolet and visible light play a role in how they form. Experts stress that informing the patient is key to managing these marks. You can read more about how dark marks form in our guide article What causes pigmentation (dark patches) on the skin?.

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Why Do Acne Scars Matter?

Acne scars are not only a matter of appearance; they have a measurable effect on quality of life. In a survey carried out in several countries with 723 adults who had acne scars on the face but no active acne, the effect on quality of life increased as scar severity increased. People with mild scars also reported a significant effect on their quality of life. Clinical features consistent with concerns about body image were found in 16.9% of participants.

In the same survey, the emotional difficulties reported most often were constantly monitoring one’s own appearance and worrying that the scars would never go away. Although research in this area is still incomplete, publications state that scars can be a source of distress independent of active acne, and that people with scars can carry a significant psychosocial burden, including depression.

The impact of scars on a person is real, and the response to that impact also needs to be realistic. So knowing the limits of treatments clearly is just as important as taking the burden of scars seriously; the decision should be made with both in mind. If your scars are causing you significant distress, it is a good idea to talk about this at your consultation as well.

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Evidence for Mesotherapy in Acne Scars Is Limited

Evidence showing an effect of mesotherapy on pitted acne scars is limited. In the literature search carried out, no controlled study was found that directly measured the effect of classic mesotherapy alone on pitted (atrophic) acne scars. Data on injectable methods mostly come from treatments given in addition to other procedures.

PRP (platelet-rich plasma), prepared from a small sample of your own blood, is a typical example. According to an umbrella review (a review of systematic reviews) on this subject, most studies looked at PRP combined with microneedling or laser. Groups that also received PRP showed greater clinical improvement and satisfaction, but the certainty of the evidence was rated low or very low. According to the researchers, this level of certainty does not support a clear clinical decision about using PRP.

Data comparing the methods with each other are also uncertain. In a comparative analysis of 68 randomised trials (a network meta-analysis), PRP or filler combined with laser ranked near the top for reducing scar severity. By contrast, a more recent network meta-analysis, based on a sparse network of nine randomised trials, stated that there is currently no reliable ranking of treatments, that confidence in the evidence is low or very low, and that no study reported results separately by scar type.

Fillers (dermal fillers) are a separate topic: unlike mesotherapy, they aim to support the hollow beneath a scar by adding volume. A review of 24 studies reported that different types of filler improved scars. In a randomised split-face study with 30 patients, the effects of two different hyaluronic acid products became noticeable at different times. These results apply to fillers and cannot be transferred to mesotherapy.

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Other Approaches Described in Research

Several methods have been described for acne scars, and no single method works for every type of scar. A systematic review of methods that do not use energy covered subcision (using a needle to release the bands that tether the scar to the tissue beneath), dermabrasion (mechanically sanding down the surface of the skin), microneedling, fillers and chemical peels.

These methods are used with varying levels of effectiveness. Each has advantages and disadvantages, and there is no easy, definitive solution for acne scars. Studies with more patients are needed to reach firmer conclusions about effectiveness. According to a recent review of developments in acne scar treatment, across a range that runs from physical methods such as microneedling to energy-based devices such as fractional laser, combination approaches that use chemical peels, laser and fillers together stand out.

In the network meta-analysis comparing methods, combinations that included laser ranked near the top for scar severity. However, there was no strong evidence that any treatment reduced the risk of redness or post-inflammatory hyperpigmentation (dark marks left after acne or inflammation) compared with the others. These methods are listed neutrally and for information only. This is not a recommendation, and it does not mean that these methods are offered at this clinic.

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Limits of This Treatment

Mesotherapy does not treat active acne and does not erase acne scars. At most, it can be discussed as a supportive approach that may be considered for a specific scar or post-acne change. Publications are clear on this: there is no easy, definitive solution for acne scars, and scars are a separate condition that needs a different approach from active acne.

In practice, this limit means the following. New scars can form while acne continues, and early, effective acne treatment is emphasised as important for reducing the risk of scarring. So the disease needs to be brought under control first. Narrow, deep ice pick scars are not the same problem as wide, rolling scars. Raised (hypertrophic) scars and keloids are a separate group from pitted scars and are outside the scope of this topic. Redness and dark marks form through different mechanisms from scars in the tissue.

The evidence itself also sets a limit. For injectable methods in acne scars, the certainty of the evidence is low or very low, and the methods cannot currently be ranked against each other. For this reason, no improvement rate, duration of effect or number of sessions is given; such a figure would suggest a certainty that the sources do not support.

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If You Are Taking Isotretinoin

If you are taking oral isotretinoin for acne, or have taken it recently, you must tell us at your consultation. This is because the timing of skin procedures during this period is debated. For many years, it was widely taught that skin procedures should be postponed during isotretinoin treatment or immediately afterwards. However, a systematic review and consensus study that examined this view across 1,485 procedures stated that it was based on three small case series (publications describing a small number of patients) from the mid-1980s.

According to the study’s conclusions, there is not enough evidence to support postponing superficial chemical peels, skin surgery, laser hair removal or fractional laser procedures. In contrast, mechanical dermabrasion and fully ablative laser (laser that removes the entire surface layer of the skin) are not recommended during isotretinoin treatment. A consensus report from the American Society for Dermatologic Surgery reached a similar conclusion for superficial peels and non-ablative lasers.

A more recent review takes a more cautious view. It states that, where possible, surgical procedures can be postponed until the effect of the retinoid has lessened, and that extra care is important in darker skin phototypes. The summaries of these publications do not address mesotherapy separately. For someone taking isotretinoin, the timing of any injection is assessed individually and needs to be discussed with the doctor who prescribed the medicine.

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Known Risks

Although mesotherapy is known as a relatively safe method, unwanted reactions have been reported. Some of these can lead to the very outcome that someone seeking treatment for acne scars wants to avoid: a new scar. Publications on mesotherapy complications include many cases with side effects of varying severity. In most cases, the treatment of these side effects is tailored to the individual, and larger studies are needed to assess safety.

One serious risk that has been studied in detail is infection. A systematic review of non-tuberculous mycobacterial (NTM) infections linked to mesotherapy brought together 423 patients from 30 publications. Most infections cleared up with antibiotics. However, many patients needed more than one course of antibiotics, recovery took weeks, and scarring after treatment was common. The researchers state that these infections arose from contamination of the injections from the environment. Most of these cases involved treatments on the abdomen, buttocks and thighs.

Other risks are more common but milder. Publications on the use of fillers for acne scars reported temporary redness, swelling and bruising as common, and nodules (small lumps under the skin) and dark marks as rare. Acne-related dark marks occur mainly in darker skin phototypes, so this tendency should be discussed before any procedure on the skin. In a randomised trial in people with oily skin, colonisation by an acne-related bacterium in the T-zone was seen to increase after mesotherapy; this finding has not been separately confirmed in patients with acne.

Before the procedure, you will be asked whether you take blood thinners, antiplatelet medicines or supplements that can affect bleeding. Do not stop any prescribed medicine on your own. If needed, the procedure is planned or postponed after consulting the relevant doctor. The risks listed here must be explained to you in detail before you decide on treatment.

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