Body Mesotherapy

What is body mesotherapy?

Body mesotherapy means giving many small injections under the skin through fine needles, in areas such as the abdomen, waist, thighs or arms. In everyday language, the term is mostly used for localised pockets of fat. Mesotherapy was first developed in France to treat painful conditions, and over time it became best known in cosmetic dermatology for fat reduction. However, there are few rigorous studies showing that it is effective and safe for this purpose.

Body mesotherapy can refer to two different treatments. The first is injection lipolysis: substances that destroy fat cells by disrupting their membrane are injected directly into the fat tissue. The most researched of these substances are deoxycholate and phosphatidylcholine. The second involves mixing different ingredients and injecting them in very small amounts, as in classic mesotherapy. Most of the available evidence relates to the first group, injection lipolysis.

Injection lipolysis is increasingly used to reduce localised fat, but systematic data on its safety and effectiveness are still limited. Safety depends largely on knowledge of anatomy, patient selection and carrying out the procedure according to proper standards. Alongside evidence-based practices, this field also includes outdated or inappropriate ones; a consensus statement on mesotherapy names telling the two apart as one of its aims.

RELATEDMesotherapy

SOURCEPMID 21808584PMID 42559057PMID 41627453

What do lipolysis, lipodissolve and intralipotherapy mean?

All of these are names given to the same idea at different times and in different countries: injecting a substance that breaks down fat cells into fat tissue. Scientific publications also group the names mesotherapy, lipodissolve, phosphatidylcholine-deoxycholate, injection lipolysis and adipolysis together under injections for localised fat reduction. After the initial enthusiasm, these methods came under critical scrutiny from both the media and the US Food and Drug Administration (FDA).

Injection adipolysis means injecting substances that damage cells into fat tissue to reduce volume. Intralipotherapy is a name used mainly in Europe; it describes an injection technique in which a substance that breaks down fat cells is injected directly into fat tissue with a long needle. The publication that describes this technique refers to the substance used as a CE marked product.

This difference in names matters in practice, because different substances, concentrations and techniques can be used under the same name. When assessing a treatment, look not at its name but at which substance will be injected, into which tissue, by what method and by whom.

SOURCEPMID 21824545PMID 28210398PMID 27826479

How do substances that break down fat cells work?

These substances disrupt the fat cell membrane and cause the cell to die; the dead cells are cleared away by an inflammatory process in the tissue. Early treatments used preparations of sodium deoxycholate and soy-derived phosphatidylcholine that had been approved in some countries outside the US for intravenous use (into a vein) for other purposes. At first, phosphatidylcholine was thought to be the active ingredient; later research showed that sodium deoxycholate on its own can also destroy cells in the laboratory.

These substances have been reported to have an affinity for fat tissue and to leave the overlying skin layers relatively unharmed. Laboratory data also show that deoxycholate affects fat cells more than nerve tissue, meaning it has relative tissue selectivity. However, relative selectivity does not mean that the substance affects only fat cells: incorrect injection technique can lead to complications such as skin necrosis (death of skin tissue) and nerve paralysis.

In a small randomised trial (a trial in which participants are randomly assigned to groups) that tested a phosphatidylcholine-deoxycholate mixture in the lower abdomen, the thickness of fat under the skin decreased significantly on the treated side, and tissue samples showed inflammatory cells building up within a short time. The researchers concluded that the effect came about through fat cell death. In the same study, a marker of inflammation in the blood (C-reactive protein), blood fats and blood sugar did not change.

SOURCEPMID 28210398PMID 42559057PMID 23439063

The abdomen and waist

The lower abdomen and the flanks (sides of the waist) are among the body areas where injection lipolysis has been studied, but the data come from a small number of small studies. The randomised trial that looked at fat under the skin of the lower abdomen enrolled 13 women who had a body mass index of 30 or below and were considered suitable for small-volume fat removal (liposuction); 7 of them completed the study. Below the navel, one side was treated and the other was left untreated for comparison; fat thickness decreased significantly on the treated side. However, the study was open-label, meaning it was known which side had been treated, and the sample was very small.

In a study of deoxycholate in the flanks, 30 participants who had mild or moderate fat in this area and completed the study received two sessions six weeks apart. At week 12, improvement in appearance was reported in 86.7% of participants, and significant reductions in waist circumference and fat thickness were measured. Side effects were reported to be mostly mild or moderate and limited to the treatment area.

The summary of this study does not mention a comparison group, and follow-up was limited to 12 weeks. In addition, an upper limit was set on the amount given into each area per session. So these results reflect treatment of a limited area with a small volume; they cannot be directly applied to larger areas or to the long term.

SOURCEPMID 23439063PMID 40888414

Thighs, arms, back and other body areas

Injection lipolysis has also been reported in areas such as the thighs, arms, back and bra line, but the evidence for these areas is even weaker than for the abdomen and waist. In an observational study at a single institution, 201 people received deoxycholate in various areas such as the jawline, abdomen, thighs, arms, back, chest, neck and knees, with an average of 1.8 sessions per person. Rather than measuring effectiveness, this study shows how the treatment was carried out and what side effects occurred; you can find these side effects in the Known risks section below.

A systematic review (a review that brings together and evaluates the studies on a topic) of uses outside the area under the chin found ten relevant publications. Besides areas such as the face, bra line, feet and the junction between the buttocks and thighs, these publications covered paradoxical fat increase, which can occur after fat reduction by cooling, and the shrinking of benign lumps made of fat tissue. The results were judged favourable, but the review also noted that larger studies are needed.

Another review, which looked at cosmetic use in different body areas across eleven studies, also found favourable preliminary findings. However, because there are no studies with a high level of evidence, recommendations for these off-label uses (outside the uses covered by the product's licence or approval) are weak, and consistent treatment protocols and assessment methods are needed. In short, whatever the area, there are few studies with a high level of evidence for the body, and protocols vary from study to study; a result in one area cannot be directly applied to another.

SOURCEPMID 36326562PMID 31334926PMID 34537786

How strong is the evidence?

The strongest evidence for injection lipolysis comes not from the body but from the area under the chin (the submental area); evidence for body areas is clearly weaker. A meta-analysis that combined randomised controlled trials under the chin (trials in which participants are randomly assigned to a treatment or comparison group) assessed five trials with 1,838 participants; deoxycholate was found to be better than placebo (a dummy treatment) on all measures of effectiveness. In another meta-analysis that asked the same question and also looked at how the studies were funded, only five of the 5,756 records screened could be included. Only two of these had a low risk of bias, and possible industry bias (bias from manufacturer funding) was found in all of the studies. The researchers rated the certainty of the evidence as low to moderate.

The picture for body areas is weaker. A 2026 systematic review of uses outside the area under the chin covered 25 studies and 3,178 patients, looking at deoxycholate, phosphatidylcholine and newer mixtures together. Of these studies, 93.75% reported a reduction in localised fat, but the reduction was statistically significant in only 37.5%. Patient satisfaction ranged from 57.1% to 86%.

According to the same review, new clinical studies are needed to standardise protocols and assess long-term effectiveness. Under the chin, studies have shown the effect lasting for up to three years; however, more extensive studies are needed to show safety and effectiveness in larger body areas.

SOURCEPMID 33523775PMID 37806137PMID 41296813PMID 39902824

Why is it not a weight-loss method?

Body mesotherapy does not aim to make you lose weight; it aims to reduce fat under the skin in a limited area. Scientific publications also describe it as a localised fat reduction method and stress that its safety depends on patient selection. The people enrolled in studies usually have limited fat in a specific area; for example, the randomised trial of the lower abdomen included only women with a body mass index of 30 or below.

There is also a practical reason for this: the amount that can be injected is limited. The flank study also set an upper limit on the amount given into each area per session. A systematic review of the side effects of deoxycholate reported that large-volume injections are more likely to cause serious side effects. In other words, targeting a larger area or more fat also increases the risk.

No metabolic benefit has been shown either: in the lower abdomen study, blood fats and blood sugar did not change after treatment. The injections require several sessions; the cost-effectiveness of combining them with other weight-management approaches still needs separate research. Being generally overweight is a different issue that requires its own medical assessment.

SOURCEPMID 42559057PMID 23439063PMID 40888414PMID 31977503PMID 41296813

Regulatory status: which substance, which approval?

The regulatory status of substances injected to reduce fat (in other words, the purpose for which they are approved or certified) varies from country to country and from product to product. According to a 2026 systematic review, deoxycholic acid is the only substance with FDA approval in the US for reducing fat under the chin; use in areas other than under the chin is an emerging field. Deoxycholate is used off-label (outside the uses covered by the product's licence or approval) for aesthetic purposes in other areas of the body.

The history of phosphatidylcholine-deoxycholate mixtures carries the same uncertainty: early treatments used preparations that had been approved for intravenous use (into a vein) for other purposes. In Europe, some solutions containing deoxycholate came into use through a different regulatory route. One publication describes the substance used in intralipotherapy as a CE marked product, while another refers to a similar product as a medicine approved in the European Union for reducing localised fat. The fact that the same class of product is described in such different ways shows how fragmented the regulatory picture is.

A product being approved or certified does not mean it is safe in every area and in every amount; an approval covers a specific intended use for a specific product. So before treatment, it is worth asking: Which product will be used? What is the product's registration or conformity status in Türkiye? Does the manufacturer's intended purpose cover the area to be treated?

SOURCEPMID 41296813PMID 39902824PMID 28210398PMID 27826479PMID 35832164

Known risks

The most common side effects of injection lipolysis occur at the treatment site and affect most people. In the observational study that followed 201 people treated in various body areas, all patients had swelling after every session; numbness was reported in 99.6%, tenderness in 94.2%, bruising in 33.1% and muscle weakness (paresis) in 2.6%. These figures come from a single institution; they are not data from this clinic.

In the meta-analysis of randomised trials under the chin, compared with people who received placebo, those who received deoxycholate had a higher risk of tissue hardening (fibrosis), pain, redness, numbness, swelling, oedema, itching, nodules (small firm lumps you can feel under the skin), headache and tingling. According to a systematic review of the side effects of deoxycholate, side effects are mostly mild and local; however, more serious problems such as severe pain and dizziness have also been reported in rare cases.

Skin death (necrosis) is a rare but serious complication. In a US database of reported events involving medical products, 21 events related to treatment under the chin were reviewed; three of them were skin necrosis. Two patients were treated in hospital for this, and both had an underlying systemic disease. To reduce the risk of skin ulcers (open sores) and necrosis, it is recommended not to inject into the skin itself (intradermally). To reduce the chance of an abscess, it is recommended to follow strict germ-free working practices (asepsis).

Similar cases have been reported in body areas. One published case describes severe pain, local skin necrosis and painful nodules that opened onto the skin after a deoxycholate injection given too superficially by an untrained person. Another reported case describes inflammation of the fat tissue (panniculitis) in the buttocks and thighs after mesotherapy for localised fat with a mixture containing deoxycholate; cultures were negative, meaning the inflammation was not caused by germs, but the condition can be mistaken for an infection. Before the procedure, you will be asked about blood thinners (anticoagulants), antiplatelet medicines (which stop blood platelets from clumping together) and 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.

RELATEDWhat to Expect After a Treatment

SOURCEPMID 36326562PMID 37806137PMID 31977503PMID 39553813PMID 39247122PMID 35832164PMID 31789264

Infection and rare serious complications

Among skin infections after mesotherapy, one group stands apart: infections caused by non-tuberculous (atypical) mycobacteria (NTM). A systematic review that brought together cases linked to mesotherapy examined 423 patients from 30 publications. Most of the patients were women; the infection mostly appeared on the abdomen, buttocks or thighs as multiple localised lesions, almost always without general (systemic) symptoms. According to the review, these infections come from injections contaminated from the environment.

Most infections cleared up with antibiotic treatment; however, many patients needed more than one course of antibiotics, recovery took weeks and scars were often left. In a study of 28 patients with infections linked to cosmetic procedures, the average incubation period (the time from catching the germ to the start of symptoms) was three weeks and the average time to diagnosis was 9.8 weeks; the authors stressed that these infections are often missed. So if painful, red or discharging swellings appear weeks after treatment, you need to tell the doctor who treated you.

Outbreak investigations show that transmission can be linked to the procedure itself. In a French study of 85 cases linked to healthcare and cosmetic procedures, the source in 10 cases, where samples from the environment and from patients were genetically similar, was most likely the water used in the procedures; the authors noted that using sterile water in all invasive procedures could reduce the risk of these infections. In an outbreak in Canada, four people were shown to have had mesotherapy from the same beauty therapist within one month, and the germs were almost genetically identical.

Rare whole-body (systemic) reactions have also been reported: one case of acute respiratory distress syndrome (severe breathing failure that develops suddenly) about 30 minutes after lipolysis injections at unlicensed premises, and one case of severe liver damage after an injection containing deoxycholate, phosphatidylcholine and L-carnitine. These are individual cases and give no information on how often such events occur; but they show why injections whose contents and setting are unknown carry a separate risk.

SOURCEPMID 39916988PMID 40353203PMID 35195516PMID 42603027PMID 41721501PMID 42784428

Limits of this treatment

The limits of body mesotherapy are clear on several points. The first is scope: the method targets fat under the skin in a limited area. It does not cause weight loss or reduce overall body fat, and fat around the internal organs is not a target of this treatment either. The limits are also clear in terms of evidence: there are few data on long-term results in body areas, and protocols are not standardised.

The second is the cause of the fullness, because not all fullness is fat. To take an example from the jawline: according to a review of fat-reducing injections, if sagging is caused by tissue compartments shifting position, surgery should be preferred; if it is caused by thinning of the tissue under the skin, fat-reducing treatments are contraindicated, meaning they should not be used. This example concerns the face; on the body, if fullness is caused by skin laxity (loose skin), the sources reviewed contain no data showing that fat reduction tightens it.

The third is future procedures. In a retrospective study of 180 patients who had a surgical neck lift, people who had previously had non-surgical procedures such as lipolysis injections, fat reduction by cooling, energy-based devices or threads showed tissue hardening (fibrosis), loss of tissue layers and unpredictable fat distribution during surgery; in all of these cases, the operation took longer. These data concern the neck and do not separate the procedures from one another; even so, they show that non-surgical procedures of this kind can leave changes in the tissue and can affect surgery you may consider in the future.

The fourth is cost and comparison. Because the injections require several sessions, they can cost more than single-session surgical fat removal. Cellulite, the dimpled appearance of the skin surface, is a separate issue from localised fat and is covered on the Cellulite Mesotherapy page.

RELATEDCellulite Mesotherapy

SOURCEPMID 41296813PMID 34537786PMID 39247122PMID 40712094