Mesotherapy was first introduced in France by 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.

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 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 3 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.

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.

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.
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