International Consensus Guidelines on the Safe and Evidence-Based Practice of Mesotherapy: A Multidisciplinary Statement

Abstract

Introduction. Mesotherapy is a widely used technique around the world. However, there is currently no internationally recognized, evidence-based standard for its various clinical applications. To address this gap, we have reviewed the current state of the art, critically evaluated its clinical benefits and limitations, and proposed a set of standards including procedural steps, recommended actions, and practical instructions in the form of protocols, guidelines, and expert recommendations. Methods. A team of researchers conducted a comprehensive literature review, selecting studies published between 1976 and 2023. Drawing on the available evidence and the needs expressed by patient associations, 23 clinical questions were developed and presented to a panel of experts. Through multiple rounds of evaluation, evidence-based recommendations were formulated and subsequently submitted for structured evaluation and voting by a broad, multidisciplinary panel of international experts, representing numerous national and international scientific societies. Results. The recommendations outlined in this guideline support the use of mesotherapy across diverse clinical and organizational settings, providing a standardized framework that ensures both efficacy and patient safety in osteoarticular pain, rehabilitation, and dermatological fields. Conclusions. The era of mesotherapy based on personal beliefs now gives way to evidence-based practice. The limitations underscore the need for continued high-quality research and scheduled guideline updates.

Keywords: dermo-esthetic; guideline; mesotherapy; pain; phlebology; sport medicine.

Figure 1

This figure illustrates the steps of the entire scientific process. The literature review included studies published up to December 2023. The drafting of the final document was completed in October 2024, and the final draft of the publication in April 2025. The number of experts involved in each committee is reported, while the duration in months for each phase is shown in parentheses.

Figure 2

The figure schematically shows the skin layers and the 4 mm needle (in red). The 4 mm needle length represents the side of an equilateral triangle (dashed lines). AB represents the needle with a length of 4 mm. AB inserted with an inclination of 30° constitutes one side of an equilateral triangle (ABC). AB = 4 mm; DB = 2 mm. By increasing or decreasing the angle, different injection depths can be achieved. Note that in the figure, the 4 mm needle length represents the side of an equilateral triangle (dashed lines).

Figure 3

Mesodermal modulation. The figure schematically shows the possible mechanisms of action. The drug triggers local reactions and is slowly absorbed systemically. In the dermis, the distension of the tissues induced by the needle and the injected drug contribute to the analgesic effect.

Figure 4

The figure shows a decision-making algorithm for the application of mesotherapy in chronic venous disease (CVD) and edematous-fibrosclerotic panniculopathy (PEFS) based on disease staging and treatment outcomes.

Figure 5

The figure shows the treatment algorithm for mesotherapy alone or in combination with other therapeutic strategies.