Facial Mesotherapy

What is facial mesotherapy?

Facial mesotherapy involves making many small injections into the skin of the face with fine needles, placing substances that are compatible with the body (biocompatible) in different layers of the skin. Facial rejuvenation is one of the uses of the method. The target is the skin itself: hydration, elasticity, surface smoothness and fine lines.

Mesotherapy is not specific to the face or to aesthetics. According to a recent expert consensus, it is a minimally invasive technique used in many fields, including pain management, sports medicine, rehabilitation, vascular disease, dermatology and aesthetic medicine. Facial mesotherapy is the branch of this broad family that is applied to the skin of the face; treatments for the scalp, the body and pigmentation are covered on the Hair Mesotherapy, Body Mesotherapy and Pigmentation Mesotherapy pages.

The name of the treatment does not tell you what is in the syringe. ‘Facial mesotherapy’ is the name of a way of giving treatment, not the name of a product. Two treatments given under the same name can involve completely different injected contents. So the question that really matters is: what is being injected?

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Why is the injected mixture not standardised?

The contents used in facial mesotherapy are not a single substance but a wide range, and there is no common standard for them. A few examples from studies show how large the differences can be.

One study on facial rejuvenation used two different mixtures: one contained hyaluronic acid, vitamins, amino acids, minerals, coenzymes and antioxidants; the other consisted of hyaluronic acid and an antioxidant called idebenone. Another study, a randomised trial (a trial in which participants are randomly assigned to groups), used a solution containing four amino acids (glycine, proline, leucine and lysine) added to sodium hyaluronate. A further study used a solution containing hyaluronic acid particles and choline.

Hyaluronic acid is not all the same either. If its chains are chemically linked to each other, it is called cross-linked hyaluronic acid; if they are not, it is called non-cross-linked hyaluronic acid. In a review of mesotherapy studies using hyaluronic acid, 23 of the 34 articles examined used non-cross-linked hyaluronic acid and 11 used cross-linked hyaluronic acid. The reported treatment schedules also differed between the two groups: with non-cross-linked products, 1 to 6 sessions at intervals ranging from weekly to every two months; with cross-linked products, 1 to 3 sessions 4 to 36 weeks apart.

Substances called polynucleotides are also used in skin renewal injections known as biorevitalisation. In a systematic review (a review that searches for the studies on a topic using set criteria and brings them together) covering nine studies and 219 patients treated with these substances, the quality of the studies was rated as low to moderate; the treatment area and technique also varied from study to study.

The lack of standards also affects safety: in a review of complications linked to mesotherapy, adverse reactions were associated with the method’s widespread use and lack of standardisation. At the clinic, when products classed as medical devices are assessed, approval by the US Food and Drug Administration (FDA) is not a criterion on its own. The assessment is based on CE marking, registration and conformity status in Türkiye, and the manufacturer’s intended purpose.

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What does ‘skin quality’ mean?

Skin quality is the main target of facial mesotherapy, but it is not defined by a single measure. According to the consensus of an international advisory board, skin quality can be defined, across all ethnic backgrounds, by four perceived characteristics: evenness of skin tone, smoothness of the skin surface, skin firmness and radiance.

The board also points out an important limit: a feature seen in the skin may originate in deeper tissues. In that case, approaches aimed only at the surface may not be enough, and improving skin quality may require a plan that targets more than one layer. Of these layers, facial mesotherapy is aimed only at the skin itself.

The aims of clinical studies are consistent with this. A recent randomised trial enrolled people concerned about dry skin, dullness, visible pores, reduced elasticity or fine wrinkles. Another randomised trial, using non-cross-linked hyaluronic acid, measured skin hydration, elasticity, roughness and fine lines. Volume, facial contours and sagging were not among the outcomes measured in these studies.

This distinction matters in practice. When you look in the mirror, a face that looks tired may reflect skin quality, but it may also reflect volume loss or sagging. Facial mesotherapy is aimed only at the first of these; which one is most prominent is determined at a consultation.

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The area around the eyes and fine lines

Fine lines are one of the outcomes measured in studies of facial mesotherapy. However, the results do not all point the same way, depending on what is injected; the findings of one study cannot be assumed to apply to a different mixture.

In a multicentre randomised trial in which the assessors did not know which group they were examining, 448 adults were divided into two groups. Full-face injections into the skin (intradermal) with non-cross-linked hyaluronic acid were reported to improve hydration, elasticity, surface texture and fine lines, with a favourable safety profile. However, the comparison group received no injections; people in this group continued their usual skin care. In other words, there was no group given a placebo (a dummy treatment), in which the same procedure is carried out without the active ingredient.

Around the eyes, the picture is different. In a study of mesotherapy for wrinkles around the eyes, using a solution containing multivitamins and plant extracts, six volunteers had six sessions two weeks apart. Clinical assessments at the start, at the end of treatment and three months after treatment showed no significant difference. Skin samples (biopsies) also showed no statistically significant change in collagen or elastin.

This second study is very small and, because it looked at a single mixture, it does not give a definitive answer. Still, it shows that there is no basis for a general claim such as ‘vitamin mesotherapy gets rid of wrinkles’. The difference between the two studies is a reminder of a basic point: what determines the result is not the name of the treatment but the substance injected and how the study was designed. The assessment specific to the eye area is covered on the Eye Area Mesotherapy page.

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Where does the evidence stand?

The evidence on facial mesotherapy is mixed: there are controlled studies for some hyaluronic acid treatments, while the evidence for vitamin mixtures and cocktails is weaker.

According to an updated critical review of mesotherapy for skin rejuvenation, the method is controversial and evidence of its effectiveness is still lacking. The researchers state that they have found no new clinically valuable data since their previous review, and they conclude that, until more definitive data are available, the method cannot be recommended for routine skin rejuvenation.

A systematic review brought together 13 studies on the effect of injected hyaluronic acid on facial skin quality. Eight of them looked at hyaluronic acid alone, and five at mixtures of hyaluronic acid with other active ingredients (cocktails). Significant improvements in hydration, firmness, radiance, surface texture and elasticity were reported, and the effect of hyaluronic acid alone was more marked than that of the cocktails. Even so, the review’s conclusion is cautious: large randomised trials are needed.

Larger randomised trials have been published in recent years. One, using a solution of sodium hyaluronate and amino acids, enrolled 456 people, 439 of whom completed the study; the other, using non-cross-linked hyaluronic acid, included 448 adults. In both, the comparison group received no injections, and both looked at a single product. A comparison with a group that received no treatment at all does not give the same information as a placebo-controlled comparison, in which the same procedure is carried out without the active ingredient.

Among the sources reviewed, the placebo-controlled study was carried out not on the face but on the backs of the hands: 22 women received hyaluronic acid in one hand and saline (salt water) in the other, and 18 completed the study. At the end of week 4, 13 of them showed an increase in the density of the dermis (the middle layer of the skin) on high-frequency ultrasound images; the subsequent analysis was carried out in this responder group. The authors of an uncontrolled study (a study with no comparison group) of 40 people, using a solution of hyaluronic acid and choline, themselves list the small number of participants and the lack of a control group as limitations of their study.

An international expert consensus also states clearly that there is no internationally accepted, evidence-based standard for the various clinical uses of mesotherapy, and stresses that the field still needs high-quality research.

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The difference between facial mesotherapy and skin boosters

The short answer: the two terms overlap even in scientific publications; the difference usually lies not in the name but in the substance injected. Mesotherapy is the name of a technique for giving treatment. The English term ‘skin booster’ is used for injectable products aimed at skin quality that are given into the skin.

For example, the sodium hyaluronate and amino acid solution studied in a randomised trial is described as a skin booster delivered by mesotherapy; the researchers also note that injecting skin booster products into the skin using the mesotherapy technique is becoming increasingly common. In other words, the same treatment may be called mesotherapy in one source and a skin booster in another.

Distinguishing by contents tells you more. In mesotherapy studies using hyaluronic acid, non-cross-linked and cross-linked products were studied as separate groups, and different treatment schedules were reported for the two groups. In the systematic review of facial skin quality, treatments using hyaluronic acid alone were also assessed separately from cocktails made with other active ingredients, and the two were not found to have the same effect.

The product group known as skin boosters is covered on the Skin Boosters page. The real question to ask at your consultation is not what the treatment is called, but which class of substance is in the syringe.

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Limits of this treatment

Facial mesotherapy is a treatment aimed at skin quality; it does not add volume, tighten sagging skin or lift the face. This limit can also be seen in what the studies measure: the outcomes measured are hydration, elasticity, surface texture and fine lines, not volume, facial contours or the position of tissues.

The expert consensus on skin quality draws the same limit from another angle: a feature seen in the skin may originate in deeper layers, and in that case an approach aimed only at the skin may not be enough. If you have volume loss or sagging, facial mesotherapy does not address the problem; other methods are considered for these.

The effect is not permanent either. According to a review of mesotherapy studies using hyaluronic acid, maintenance treatment is needed every few months to maintain the aesthetic result; particularly in older people with advanced sun damage, additional rejuvenation methods are needed to support the result. In short, facial mesotherapy should not be seen as a procedure that is enough on its own or that is completed in a single session.

Facial mesotherapy is not a substitute for a surgical facelift. This information is not given to put you off, but to help you set realistic expectations. Which path makes sense for you is decided through the assessment at your consultation and by your own decision; having no treatment at all is also a valid outcome.

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Known risks

The side effects of mesotherapy, and therefore of facial mesotherapy, have not yet been well defined in a systematic way; most of what is known comes from individual case reports and from publications describing groups of patients (case series). A review of publications on complications of mesotherapy reported side effects of varying severity and found that, in most cases, their treatment was planned individually; the researchers stress that larger systematic studies are needed to clarify the safety profile. In treatments with hyaluronic acid, placing the substance in the correct layer of the skin is considered key to reducing side effects such as skin irregularities and the Tyndall effect (a bluish tint under the skin).

The main problem that appears later is granuloma: nodules (small lumps that can be felt in the skin) that the body forms in reaction to the injected substance, with redness and swelling, and that do not go away easily. Authors who reported a patient with multiple treatment-resistant granulomas after mesotherapy for skin rejuvenation stress that this reaction can occur even with ingredients traditionally considered safe, and that diagnosis and treatment are more difficult when the responsible substance cannot be identified. A study describing the treatment of 31 patients who developed foreign body granulomas after mesotherapy on the face, and a case series of six patients who developed non-infectious granulomatous reactions, show that this is a recurring problem. The authors of the case series link the risk of adverse reactions in mesotherapy to non-standardised protocols and overuse.

The injected product itself is also a source of risk. A patient has been reported who developed widespread granulomas on the face after a tranexamic acid product made for application to the skin was used in mesotherapy without authorisation. This example shows that the question ‘what is being injected?’ concerns safety as well as effectiveness.

As for sudden allergic reactions, no data specific to facial mesotherapy were found in the publications reviewed; how often these reactions occur with this treatment, and how they progress, is therefore unclear. You need to discuss any known allergies at your consultation. Before the procedure, you will be asked whether you take blood thinners, antiplatelet medicines (these stop blood platelets from clumping together) 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.

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Why is atypical mycobacterial infection covered separately?

Atypical mycobacterial infection is a rare skin infection that is difficult to diagnose and treat, and scientific publications have repeatedly linked it to mesotherapy. It is caused by bacteria known as non-tuberculous mycobacteria (NTM). Transmission most often involves inadequate sterility, non-sterile water or contamination from the environment.

In a systematic review of 92 patients with these infections after aesthetic procedures, the highest proportion of cases (34%) occurred after mesotherapy. According to the review, these infections are usually transmitted through inadequate sterility and non-sterile water; in most patients the diagnosis was missed at the first visit, and the infection sometimes left severe, irreversible effects.

Another systematic review, covering only cases linked to mesotherapy, includes 423 patients reported in 30 articles. Most of the studies were reported from South America, and the skin findings (lesions) mostly developed on the abdomen, buttocks and thighs, that is, outside the face. Most infections cleared with antibiotics, but many patients needed more than one course of antibiotics, recovery took weeks and scarring was common. Transmission is attributed to injections contaminated from the environment.

In a broader systematic review covering all aesthetic procedures, in 200 patients the median time to the start of symptoms was 28 days and the median duration of treatment was 6 months; the most common finding was nodules, and the most common cause was Mycobacterium abscessus. The species usually listed as responsible include M. chelonae, M. abscessus and M. fortuitum. A study in France used national data to examine these infections linked to healthcare and aesthetic procedures. In ten cases where samples from the environment and from the patient were found to be genetically similar, the source of infection was identified as most probably the water used in the procedure. According to the researchers, using sterile water in all invasive procedures reduces the risk of these infections.

In practical terms, this means that symptoms can start weeks after the procedure, as nodules at the injection sites that do not go away, and you may not link them to the procedure. Before your treatment, you should be told who to contact, and how, if you notice symptoms like these. Whether the product used is sterile and whether it was made for injection are also questions you can freely ask at your consultation.

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