Mesotherapy, cocktail by cocktail.

Deoxycholic acid is the bile salt that emulsifies dietary fat; injected into subcutaneous fat it lyses adipocytes, which the body then clears. The phase 3 REFINE-2 trial randomised 516 adults to ATX-101 or placebo: 66.5% versus 22.2% achieved a composite one-grade improvement in submental fat and 18.6% versus 3.0% a two-grade improvement, with volume reduction confirmed on MRI and better psychological-impact and satisfaction scores; 85.7% of adverse events in the active group were at the injection site (Humphrey 2016). The three-year follow-up of 224 patients found the response maintained in 86.4% versus 56.8% at year one and 82.4% versus 65.0% at year three, with 74% of those satisfied at twelve weeks still satisfied at three years and no new safety signals (Humphrey 2021). Most patients reached their improvement within two to four of the six permitted sessions (Dayan 2018).

The meta-analyses agree and add the caveat: five randomised trials in 1,838 participants, every efficacy measure better than placebo at both doses, withdrawals for adverse events in 6.8–9.9% (Cunha 2021); a second review found "all studies showed a potential industry bias", only two at low risk of bias, a higher risk of fibrosis, pain, numbness, swelling and nodules, and "low to moderate certainty" that it works (Inocêncio 2023). Strong for the chin, in a firm neck with fat above the muscle; the double chin guide sets it beside cryolipolysis and liposuction, and the jowls guide grades its off-label use lower down the face.

Tranexamic acid blocks the plasmin pathway that links ultraviolet light to melanocyte activation, and injecting it into the dermis puts a licensed antifibrinolytic exactly where melasma lives. In a three-arm Egyptian randomised trial the intradermal group's MASI score fell 62.7% against 39.1% for a topical cream and 4.2% in the control group — "intradermal injection of TA leads to better results than the topical application" (Badran 2021). Against the standard bleaching cream, 100 mg intradermal tranexamic acid and 4% hydroquinone both cut the score significantly at three months "without any significant differences", at the cost of mild burning at every injection (Pazyar 2023). Against the pill, with laser in both arms, oral and injected tranexamic acid produced the same score and colour changes, the same satisfaction and the same complications (Behrangi 2022).

The pooled data are the corrective. Across 28 randomised trials, oral tranexamic acid was significantly better than adjuvant treatment at 8 and 12 weeks while topical and intradermal routes were not, with heavy heterogeneity (Panchal 2024); an earlier meta-analysis reached the same conclusion — "the superiority of TXA was not detected when the topical or intradermal route was adopted" (Feng 2021); and the 2025 network meta-analysis of injectable combinations found tranexamic acid plus 4% hydroquinone the most effective, at level 3 evidence (Nukaly 2025). Moderate, matching the dark spots guide, which grades the oral route strong: injections are for the person who cannot or will not take the tablet, and they must be paired with the sunscreen and hydroquinone or azelaic acid the melasma will otherwise defeat.

The hyaluronic-acid cocktails are the respectable end of facial mesotherapy because HA itself binds water and because three of them have randomised trials. Non-cross-linked HA against saline, cheek to cheek, in 55 women improved cutometer elasticity on the HA side only and blinded complexion radiance at three months — while dermal thickness rose on both sides at one month (Baspeyras 2013). A sodium hyaluronate solution with glycine, proline, leucine and lysine, three monthly sessions against no treatment in 439 completers, reached a 97.56% global-improvement rate against 3.95%, with hydration and elasticity improved to three months and adverse events in 1.67% (Yang 2026). NCTF 135HA, the classic French cocktail of HA plus some fifty vitamins and amino acids, reduced superficial wrinkles and improved radiance against a routine anti-aging cream in a manufacturer-funded 146-person trial (Fanian 2023). The systematic review of HA skin quality found HA alone did more than HA-plus-cocktail (Ghatge 2023).

Moderate, for hydration and radiance over a few months; the skin boosters guide grades every product, including the sham-controlled trials that show how much is the needle. The point for this guide is the contrast with the next row: take the hyaluronic acid out of the syringe and the evidence goes with it.

Pigmented dark circles are melanin in thin skin, and a cocktail of tyrosinase-inhibiting vitamin C, tranexamic acid and hyaluronate is at least aimed at the mechanism. The controlled trial randomised 120 patients with periorbital hyperpigmentation to the injectable hyaluronate-vitamin C-tranexamic acid-glutathione combination or to control: greyscale values rose from 162.1 to 169.7 in the treated group, the pigmentation difference from normal skin fell from 23.0 to 14.4 units, quality-of-life scores improved, severity fell, and 96.7% reported satisfaction, while "the control group showed no significant changes" — level II evidence (dark-circle trial 2025). In a split-site randomised comparison, tranexamic acid plus vitamin C mesotherapy and PRP "showed similar rates of improvement" in 18 patients (Iranmanesh 2024); in a three-way comparison with carboxytherapy and a chemical peel, all three improved pigmentation and mesotherapy produced "a significant improvement in pigmentation and a higher level of patient satisfaction" than carboxytherapy, with more burning (Ahmed 2019).

Moderate — one decent controlled trial and small comparisons — and only for the pigment type: the dark circles guide sorts pigment from vessels from shadow first, because a hollow needs the tear-trough section of the filler guide and no cocktail will fill it. This row is the exception to the vitamin rule in this guide, because the cocktail contains two drugs with a mechanism and was tested against a control.

Dutasteride blocks both 5-alpha-reductase isoenzymes and beats finasteride by mouth; mesotherapy injects a dilute solution into the scalp to keep the drug where the follicles are. The controlled evidence is one randomised trial in female pattern hair loss: photographic improvement in 62.8% of treated women against 17.5% of controls, fewer hairs pulled out, thicker hairs, better self-assessment, and side effects no different from control (Moftah 2013). The real-world evidence is the Madrid series of 541 men and women treated roughly every three months: response could be assessed in only 86 patients at one year, most of them improved with 38.4% "marked", pain was the commonest side effect at 45.5%, and "no serious or sexual adverse events were detected" (Saceda-Corralo 2022). The 2025 systematic review and meta-analysis found studies "consistently reported improvements in hair density and thickness" with minimal adverse events and "a lack of large-scale, high-quality trials" (intralesional dutasteride review 2025); the 2026 systematic review of all injectables for androgenetic alopecia concluded that injectable therapy "may provide cosmetic benefit, particularly with dutasteride", with small samples, variable protocols and short follow-up (Beer 2026). A randomised trial of monthly against quarterly injections was published in 2026 (Sanabria 2026).

Emerging, consistent with the hair loss guide: plausible, off-label, less systemic exposure than the tablet, and "evidence of its effectiveness limited to retrospective studies in real clinical practice" in the words of the group that popularised it (Saceda-Corralo 2023). Women who could become pregnant should not be near dutasteride by any route.

Most scalp mesotherapy sold in Europe is not dutasteride but a cocktail of biotin, B vitamins, minerals, amino acids, peptides and sometimes minoxidil, marketed as a "hair booster". The two randomised trials against topical minoxidil point in opposite directions. In women, a nutrient-only cocktail produced more improvement in follicle counts on ultrasound biomicroscopy and the highest satisfaction, and the authors called it "effective, more acceptable to patients, and more tolerable" while noting "small sample size, and relatively short duration" (Hunter 2019). In men, dermoscopy, trichoscan and subjective measures "failed to show significant difference between two groups" and the authors concluded there was "no significant improvement of mesotherapy in male AGA over minoxidil" (Gajjar 2019). The systematic reviews count six randomised trials among twelve studies of 527 people with "positive efficacy… to a certain extent" (Tang 2022), 27 studies across six classes of agent with "a lack of standardized regimens" (Gupta 2023), and, most recently, multivitamin and peptide formulations as the most studied agents with harms that "included paradoxical alopecia, scarring, and acute dermatitis" (Beer 2026).

Emerging: a plausible delivery of an active drug (minoxidil) when the cocktail contains one, and a delivery of nothing in particular when it does not. The scalp is also where the worst single mesotherapy injury on record occurred — multifocal abscesses with fat necrosis and scarring alopecia needing surgical repair (Kadry 2008). The hair loss guide puts minoxidil, finasteride, dutasteride and PRP in order; a cocktail is an adjunct to those, not a substitute.

Deoxycholate lyses fat cells wherever it is injected, and phosphatidylcholine-deoxycholate mixtures have been sold for the abdomen, flanks, thighs and arms for twenty-five years under names like Lipodissolve and, as CE-marked devices, Aqualyx. The systematic review of non-submental injectables found 25 studies of deoxycholic acid, phosphatidylcholine and newer agents in 3,178 patients: "significant reductions in localized adiposity were reported in 93.75% of studies, with 37.5% achieving statistical significance", mild transient adverse events, satisfaction from 57.1% to 86%, and the observation that "injectable treatments require multiple sessions, making them costlier than single-session surgical liposuction" (Carrion 2026). The mechanistic randomised trial enrolled seven women: abdominal fat thickness fell significantly, biopsies showed adipocyte necrosis and macrophage infiltration, and blood lipids and inflammatory markers did not change (Reeds 2013). A randomised comparison of three cocktails in 75 people found circumference falling 2–4 cm per site — alongside weight loss of 2.8–5.3 kg, which explains at least part of it (Kutlubay 2011). Two practices reported smooth results in 74.5–86.5% of Lipodissolve patients and ulceration in two (Mahmud 2012).

Emerging: the fat does dissolve, the trials are small or uncontrolled, the licensed molecule is only licensed for the chin, and the injuries are in Safety. The double chin guide grades the unlicensed cocktails lower still for the chin itself, where a licensed drug exists; the upper arms and cellulite guides put body injectables beside cryolipolysis and liposuction. Not for cellulite, not for weight, not for the abdomen of someone who could lose the kilogram instead.

The vitamin-cocktail facial is the treatment most people mean by "mesotherapy", and it is the one with the clearest negative evidence. The New York study treated patients with a multivitamin and hyaluronic-acid solution and evaluated them at 0, 3 and 6 months with photographs, light microscopy and electron microscopy: "no significant clinical differences", "no significant changes" on light microscopy, and collagen fibres of smaller diameter after treatment — "multivitamin and hyaluronic acid solution facial mesotherapy does not appear to provide any significant benefit" (Amin 2006). The Egyptian study, with immunostaining for collagen types I, III and VII, newly synthesised collagen, total elastin and tropoelastin at baseline, end of treatment and three months later, found "no statistically significant changes" and "no clinical improvement" (El-Domyati 2012). The laboratory study of the reagents found two commercial vitamin solutions inducing fibroblast apoptosis or necrosis while the hyaluronic-acid products did not (Jäger 2012).

Limited, and the row that gives this guide its rule: the glow after a mesotherapy facial is real for a week or two and comes from a hundred micro-wounds and a litre of water, not from the vitamins. If the syringe held hyaluronic acid, see the row above; if it held vitamins, the better use of the money is the retinoids guide, which has decades of biopsies showing the collagen these cocktails do not make.

Cellulite is fibrous bands tethering skin over lobulated fat, and no injected vitamin, enzyme or caffeine derivative addresses the bands. The Massachusetts General review concluded that "peer-reviewed studies have not evaluated whether these effects translate clinically" and that patients "must be aware that the substances currently being injected… have not been thoroughly evaluated for safety or efficacy" (Rotunda 2005). The laboratory study of the cocktails found isoproterenol, aminophylline, yohimbine and Melilotus stimulating lipolysis in fat cells and lidocaine inhibiting it — "lidocaine is antilipolytic and should be removed from mesotherapy solutions" (Caruso 2008). The randomised comparison of an aminophylline cream and endermologie found no measurable difference between treated and untreated legs and only 3 of 35 aminophylline-treated legs subjectively improved: "the authors do not believe that either of these two treatments is effective" (Collis 1999). The single ultrasound study of intradermal mesotherapy reported reduced hypodermis thickness and grade in an uncontrolled series and called for further research "due to a limited number of published studies" (Sylwia 2017).

Limited, and the cellulite guide is where the treatments with trials — subcision, shockwave, radiofrequency, the 1,440 nm laser — are graded. Mesotherapy for cellulite is also, historically, where the largest mycobacterial outbreaks occurred, on the thighs and buttocks of young women (Safety).

Glutathione is the cell's main antioxidant and, in melanocytes, shifts pigment synthesis toward the lighter pheomelanin, which is the rationale for swallowing, injecting or infusing it to lighten skin. The 2025 systematic review found five randomised controlled trials of oral glutathione at 250–500 mg a day with "a significant reduction in the melanin index compared to placebo", topical 2% glutathione moderately effective, and, for the intravenous route, exactly one placebo-controlled study — 6 of 16 responders against 3 of 16, not significant — leading to the conclusion that "IV glutathione is contraindicated due to lack of efficacy and side effects" (Sarkar 2025). The earlier review found four studies, a trend to brightening in sun-exposed skin only, and evidence "still inconclusive due to the quality of included studies and inconsistent findings" (Dilokthornsakul 2019).

Limited, consistent with the dark spots guide, which puts the oral route at the same tier. The intradermal "whitening" and "brightening" cocktails sold in European clinics — glutathione with vitamin C, tranexamic acid and sometimes kojic acid — have no controlled trial as a whitening treatment, although the same ingredients have one for under-eye pigment (above). A clinic offering a "whitening drip" is telling you how it reads evidence.

Stretch marks are dermal tears, and the cocktails offered for them — vitamins, HA, silicon, "growth factors" — have a single comparative study behind them. Fifty patients with striae rubra were divided among tretinoin, an Nd:YAG laser, mesotherapy, microdermabrasion with trichloroacetic acid, and microdermabrasion with a salicylic-and-retinol peel: the peel combination gave moderate improvement in 60%, "mild to moderate improvement was seen with Nd:YAG laser, mesotherapy and MDA + TCA", and tretinoin the least — with no untreated arm and no blinding (Karia 2016). That is the literature.

Limited. The retinoids guide has the randomised trial of tretinoin on early red marks and the microneedling guide the needling evidence; a "mesotherapy for stretch marks" package is the needling with a mystery solution added.