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    Controversial mesotherapy: Could it be the next Botox?

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    Patient before (top) and after eye pad mesotherapy treatment. (Photos: Patricia Rittes, M.D.)
    National report — Some physicians swear by it. Others call it "bogus." Still, mesotherapy glitters with a bit of the star power that lights up one of its better-known advocates, singer Roberta Flack. Hundreds of U.S. physicians now offer mesotherapy treatments — injections of homeopathic remedies, supplements, drugs or other substances into the mesoderm — starting at $200 to $300 per session.

    But what exactly is mesotherapy? And does science back it up?

    The origins of the practice can be traced to France in 1945, when Michel Pistor, M.D., began injecting small quantities of drugs into the mesoderm as a treatment for deafness. He later experimented with various drug concoctions to treat pain, arthritis, inflammations and tendonitis. In 1952, he published the first professional paper on mesotherapy. Two of Dr. Pistor's more prominent students were Jacques Le Coz, M.D., of France and Patricia Rittes, M.D., of Brazil. Dr. Rittes introduced mesotherapy to Brazil in 1986, then veered off in a new direction.

    Explains Paul Rose, M.D., a dermatologist with cosmetic practices in Tampa and Minneapolis, "Patricia Rittes got the idea of injecting phosphatidylcholine (PPC) to resolve fat deposits, and was very successful."

    Though the kinship is close, Dr. Rittes describes her modality not as "mesotherapy" but as the "Lipodissolve technique." Her published research (Aesthetic Plastic Surgery (November 12, 2003) and Dermatol Surg. 2001; 27(4):391-392) describes successful use of PPC injections to resolve lower eyelid fat pads and other localized fat deposits in lieu of blepharoplasties or suction lipectomies.

    Interest in mesotherapy did not reach the United States until a few years ago, after Lionel Bissoon, M.D., (an osteopath who trained with Dr. Le Coz) began describing his success in treating overweight patients — among them Roberta Flack — to an attentive women's magazine audience. His Web site defines mesotherapy as "a medical specialty that involves injecting microscopic quantities of natural extracts, homeopathic agents, pharmaceuticals and vitamins into the skin."

    Banned in Brazil?

    According to American Academy of Dermatology staff, the organization does not have an official position on mesotherapy; however, Debra Jaliman, M.D., speaking both as a dermatologist and as a medical spokeswoman for AAD, calls mesotherapy a "bogus treatment."

    "People like it," she says, "because they don't want to diet or exercise. But it was banned in Brazil, which never bans anything. If people are going to spend money, they should spend it on something that's been proven to work."

    Lybia Salles, assistant to Dr. Rittes, offers clarification.

    "In 2003, Aventis Pharma started to receive phone calls from people in Brazil who wanted to use Lipostabil (a patented form of PPC) to treat fat. They were asking for information about the product. The company wrote to Anvisa, the Brazilian FDA, and explained they were not aware of this use. Anvisa then forbade this specific use of Lipostabil," she says.

    The proof's in the cellulite Dissatisfied with other cellulite treatments, Sharon Littzi, M.D., a dermatologist with practices in Greenwich and New Canaan, Conn., also went to France for mesotherapy training under Dr. Le Coz, and, thanks to her fluency in French, was able to study the original literature and textbooks. Dr. Littzi reports she did not uncover any "true double-blind trials."

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    Rebecca Bryant
    Rebecca Bryant is a medical writer based in Fayetteville, Arkansas

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