Mesotherapy, which is classfied as an alternative medical treatment and still highly experimental with lymphedema is the injection of hyaluronidase or similar substances into the lymphedemous limb. The claim is that this injection helps loosen the extracellularmatrix, thereby encouraging lymphatic flow is of doubfult therapeutic value to our condition.
I personally, have serious reservations on the procedure because like so many of the “new” treatments, there are no clinical studies, blind, double-blind or otherwise to substantiate its claim.
Furthermore, it is an invasive procedure, thereby opening the door to an entry location for bacteria and subsequent infection, cellulitis or lymphangitis. It is imperative with any invasive procedure that the attending physician have a clear understanding of the pathophysiology of lymphedema and the ramifications of exposing their patient to potential infections.
It was/is recommended by its supporters as highly effective against cellulite and/or weight. Yet, even in this area, the treatment is high controversial and not of proven benefit. Infact, Dr. Ben Krentzman, a highly respected physician who focuses on weight and obesity and who publishes an online newsletter, “The Krentzman Obesity Newsletter,” flatly states he does not recommend it.
This page is an update to the original page I posted in 2004. Since that time the medical literature has literally exploded with studies and articles involving serious and significant complications associated with mesotherapy.
I can not stress the importance of anyone considering under going this treatment to carefully read the added links below.
Disclaimer: This is presented for information only. Inclusion does not constitute an endorsement of the therapies and/or treatment. Individuals should consult with their physcians as to itts apllicability in their personal situation.
Key Words: Non-tuberculous mycobacteria, Mycobacterium abscessus, Mesotherapy, lymphedema, subcutaneous nodules, cutaneous tuberculosis
Mesotherapy is the practice of injecting small amounts of medication and/or vitamins into the mesoderm — or middle layer of skin.
The technique was pioneered in France by Dr. Michel Pistor, and has been performed there since 1952. There are some 15,000 mesotherapy practitioners in France. There are far fewer practitioners in the United States, and there is no single certification process for performing the therapy.
Mesotherapy has been used in the treatment of acne, arthritis and joint problems, sports injuries as well as for cosmetic purposes, such as reducing cellulite and weightloss. While each mesotherapy treatment may involve hundreds of small injections, the treatment sessions typically take only minutes to complete.
Some of the drugs Dr. Bissoon and other mesotherapists inject include aminophylline, an asthma medication, and isopreteranol, a cardiac medicine. Both are FDA-approved, but not for cosmetic use. Many, including Dr. Bissoon also use phosphatidylcholine, which is not an FDA-approved drug in injectible form. It is manufactured in a compounding pharmacy. Others use phosphatidylcholine in a European drug called Lipostabil, which the FDA also has not approved.
The number of mesotherapy treatments needed depends on a number of factors: the severity of the condition, the cause of the problem are chief among them. Response to therapy is generally seen after three to five sessions. Long-term, chronic conditions such as cellulite and wrinkles, may require at least 15 sessions. Sports injuries and acute conditions may require only one to three therapy sessions.
Cost of the treatments vary. The price of a single session can cost several hundred dollars.
Courtesy of ABC News
For the entire articles, which includes sections:
What is Mesotherapy? Two Patients' Progress Is it Safe? Where Does the Fat Go?
ABC News Article Link no Longer Available
THE LASTING ANSWER TO CELLULITE AND FOCAL WEIGHT MELTING
“LOSE YOUR DOUBLE CHINS” WITH MESO AND LOOK WONDERFUL
CELLULITE According to recent research, 95 percent of women suffer from cellulite. Not that they're the only ones. Less common perhaps, but men suffer from it to. So what is cellulite? Cellulite results from a combination of fatty tissue and fluid retention. Typically (although not exclusively) a female problem, it can affect women of all ages irrespective of their weight. In women, fat cells on the lower part of the body store fat six times more readily than those on the upper body. They also release them six times less readily. This makes weight loss from the lower body almost impossible without the upper body suffering unnecessarily. The answer? Mesotherapy.
MESOTHERAPY Originally a medical technique devised in 1958 by Frenchman Dr Michel Pistor to treat such conditions as Rhumatology, Sports Traumatology, Infectious diseases, Vascular diseases and the improvement of circulation, Mesotherapy has subsequently been extremely successful in the treatment of aesthetic conditions. Cellulite/Orange Peel Effect and Weight loss can be effectively managed with the use of Mesotherapy. The treatment stimulates the mesoderm, or middle layer of the skin, which in turn helps to disburse the cellulite. THE TREATMENT Mesotherapy involves injecting small amounts of homeopathic medicine immediately beneath the surface of the skin to break down the cellulite and to improve circulation and lymphatic and venous drainage. Each treatment takes about ten minutes and is not painful. After the treatment you can return to normal activities. The addition of Vitamin C to the mixture encourages the tone and quality of the overlying skin. Treatment may be carried out immediately after an initial consultation at which point you will be informed as to how many treatments you will require. Micro-injections are given twice a week over a period of 4 to 8 weeks. Some individuals may require a course of 4 weeks, although a full treatment course takes 8 weeks. The treatment is long lasting and the results measurable. When the desired effects are achieved, all that is required is annual maintenance over a 4-6 week period. Superb results are achieved and those being treated look and feel better both during and after treatment. Overall, with a moderate amount of lifestyle change,
Mesotherapy can provide measurable improvements with people losing up to 2cm from the circumference of their thighs after only 6 sessions. Read more about specific uses for mesotherapy below Weight Loss For those patients seeking weight loss, mesotherapy is a revolutionary and essential tool. This is how it works: the biology of the fat cell is modified by blocking the signals of fat accumulation and simultaneously triggering the release of stored fat. Again, the desired area of treatment can be patient specific, targeting your most problematic areas. Additionally, a complete dietary and nutrient evaluation will help you maintain your weight loss goals. Cellulite Reduction Cellulite affects the majority of women over the age 20. It is caused by poor circulation, fat herniation, a weakening of connective tissues, lymphatic congestion and hormonal imbalances. Cellulite is classified into four stages, based upon its appearance while standing, laying, and pinching the skin. Causing a dimpling and cottage cheese appearance of the skin, cellulite is not a disease of excess weight. Mesotherapy treatment is targeted to correct these problems by improving circulation, strengthening connective tissues, and dissolving excess fat.
Hair Regrowth / Alopecia Alopecia, the loss of hair, affects both men and women. Alopecia results from poor circulation, nutritional imbalances, and the excess of a hormone known as DHT (dihydrotestosterone). Mesotherapy can correct these problems, stimulating the body to naturally grow lost hair. Face and Neck Rejuvenation / Mesolift Aging, sagging and wrinkling of the skin occurs from accumulation of fat, loss of skin elasticity and excessive free radical damage. Using antioxidants and amino acids, mesotherapy can remove fat from under the neck, remove free radical damage, and tighten loose skin. The effects rejuvenate the face, eyelids, and neck without the unnatural appearance and painful recovery of surgical face lifting. Body Sculpting Contouring of the abdomen, arms, back, legs and hands can be obtained with mesotherapy.
Vitamins and amino acids are used to tighten sagging skin while other agents are used to remove areas of fat, restoring a more youthful and athletic appearance to the body's contours. Medical uses Mesotherapy also has a variety of medicinal uses. Treatments can benefit those patients suffering from muscle spasms, stress, insomnia, carpal tunnel syndrome, fibromyalgia, infections, RSD (reflex sympathetic dystrophy), and osteoarthritis, among other conditions. Such a wide variety of conditions can be treated with this technique as each treatment is formulated to meet each patient's unique problem. Mesotherapy is administered only into the problematic area, avoiding the side-effects of taking oral medications. For example, the dosage of medication used to alleviate the pain of osteoarthritis is approximately 1/50th of the comparable to the equivalent oral dose taken over a one-week period. Mesotherapy: Cosmetic uses Medical Uses · Weight Loss · Cellulite Removal · Face and Neck Rejuvenation · Hair Loss / Alopecia · Help in Quitting Smoking · Arthritis Pain · Carpal Tunnel Syndrome · Muscle Relaxation · Help with Anxiety and Insomnia · Chronic Infections · Bone Spurs Dr. M. Pistor originated the technique of Mesotherapy in France in 1952. It is commonly practiced in France, where more than 15,000 practitioners utilize Mesotherapy for the care of their patients. Mesotherapy is also practiced in many other countries around the world, including Belgium, Columbia, Argentina, and throughout Europe.
Mesotherapy is an interventional natural medicine technique. Mesotherapy must be performed by a licensed health care clinician who is permitted to do injections. At our office, Caring Medical and Rehabilitation Services, this includes the physicians, physician assistants, and nurses. The technique involves the injection of substances to stimulate the mesoderm for various biological purposes. For instance, if the mesoderm circulation is poor, a vasodilator is used; if excessive inflammation is present, an anti-inflammatory medication is used; or if inflammation/stimulation is needed; a fibroblast proliferating solution is injected. Conditions such as cellulite are due to lymph venolymphatic insufficiency, therefore a stimulator of venous and lymph flow is used. We use natural plant extracts whenever possible; however, traditional pharmacologic agents are sometimes required. Top Uses for Mesotherapy The compounds injected into the mesoderm during Mesotherapy depend upon the pathophysiology of the disease process. In general, the substances fall into the following classes: vasodilators, anti-inflammatories, muscle relaxants, decontractants (reduce contractures), proteolytic enzymes, biologics (including vitamins, minerals, and plant extracts), vaccines, anti-infectants, hormones, hormone blockers, general medicine physiologics, and anesthetics.
Mesotherapy is effective for a multitude of conditions because it helps reverse the physiology of that condition. In rheumatoid arthritis, for example, plant and pharmacologic agents are used to control inflammation; whereas connective tissue stimulators (such as silica, biotin, and proteolytic enzymes) that promote inflammation and healing would be given to the athlete with a ligament tear or degenerated tendon. The pathophysiology is multifactorial in many conditions, therefore, multiple agents are used. (See Figure 2.) Top Figure 2: Many different pharmacological and natural agents are used during Mesotherapy. Pharmacological Class Agent Purpose Vasodilator Pentoxifyilline Increase circulation NSAID Toradol Anti-inflammatory CNS sedative Norflex Muscle relaxant Enzymes Hyaluronic Acid Decrease scar tissue Nutrients Biotin Stimulate repair Vaccines Bacterial Proteins Stimulate immune system Antibiotics Metronidazole Anti-infection Hormones Progesterone Hormone replacement Hormone blockers Fioesteride Hair growth General medicines Compazine Correct physiology Anesthetics Procaine Increase circulation Calcium hormone Calcitonin Remove bone spurs Biologics Interferon Immune stimulation For example, cellulite is a condition involving the circulation as well as lymph flow of the adipose tissue; thus a vasodilator (increases blood flow), a stimulator of lymph drainage, and a lipolytic agent (breaks down fat tissue) are used. Another example of using multiple agents is for hair growth. Male and female balding is related to many factors, including excessive androgens (sex hormones), poor scalp blood flow, and nutrient deficiencies. The mesotherapy protocol for hair growth, therefore, involves use of a combination of nutrients (such as biotin, hyaluronic acid, and silica, for example), vasodilators, and androgen blockers.
Dr. Jacque Le Coz, former president of the French Society of Mesotherapy and Mesotherapist for the French National Sports Teams, has written three books on Mesotherapy, including Mesotherapie et medecine esthetique (Solal Publishing, France), Mesotherapie et traumatologie sportive (Masson Publishing, France), and Mesotherapie en medecine generale. Dr. Le Coz was privileged to become the pupil of the founder of mesotherapy, Dr. M Pistorand, and even became like a son to him. Dr. Pistor wrote the prefaces to each of Dr. Le Coz's books. Dr. Hauser received training in mesotherapy from Dr. Le Coz at his Paris clinic. As outlined in Dr. Le Coz's books, Mesotherapy has been shown to be effective for the following conditions: Sports injuries: · Arthropathy · Barre-Lieou Syndrome · Chronic Joint Swelling · Ligament Sprain · Meniscal Tear · Muscle Tear · Muscular Bruises · Overuse Injuries · Periosteitis · Plantar Fasciitis · Shin Splints · Stress Fractures · Tendon Calcifications · Tendon Degeneration · Tendon Strain Skin conditions: · Acne · Alopecia · Cellulite · Contusions · Eczema · Hair Loss · Herpes Infection · Hypertrophic Scars · Lipodystrophy · Male/Female Hair Loss · Obesity Stretch Lines · Psoriasis · Rides · Scar Disorders · Sun Damaged Skin · Telangiectasias · Venous Insufficiency · Vitiligo · Wrinkles Chronic painful conditions: · Bone Spurs · Bursitis · Calcific Tendonitis · Carpal Tunnel Syndrome · Causalgia · CervicoBrachalgia · Chondromalacia · Chronic Low Back Pain · Contractures · De Quervain Tenosynovitis · Degenerative Arthritis · Degenerative Disc Disease · Dupytren's Contracture · Fibromyalgia · Frozen Shoulder · Gout · Herniated Disc Pain · Herpes Zoster Pain · Ligament Sprain · Migraine Headaches · Muscle Spasms · Myofascial Pain · Neuralgia · Osteochondrosis · Post-Fracture Pain · Post-Surgical Pain · Post-Whiplash Pain · Pseudogout · Radiculopathy · Reflex Sympathetic Dystrophy · Rheumatoid Arthritis · Spondylolisthesis · Tarsal Tunnel Syndrome · Tension Headache · TMJ Syndrome · Trigeminal Neuralgia · Trigger Finger · Ulnar Neuropathy General medical conditions: · Allergies · Alopecia · Asthma · Autoimmune Disases · Bronchitis · Childhood Infections · Chronic Fatigue · Chronic Infections · Chronic Sinusitis · Chronic UTIs · Cigarette Addiction · Compulsive Behavior · Constipation · Coronary Insufficiency · Degenerative Arthritis · Depression · Dysmenorrhea · Gastritis · Generalized Anxiety · Genital Herpes · Glaucoma · Glossodynia · Hearing Loss · Hemorrhoids · Hepatitis · Insomnia · Irritable Bowel Syndrome · Lymphedema · Menstrual Irregularity · Migraine Headache · Obesity · Presbyopia · Prostatitis · Restless Legs · Rheumatoid Arthritis · Slow Metabolism · Slow Metabolism · Spasmatic Colitis · Vaginal/Anal Itching · Vascular Insufficiency · Vertigo Mesotherapy for Calcifications and Bone Spurs Traditional medicine currently offers only one method to remove bone spurs: surgery. Bone spurs generally form as the body's response to stabilize a weak structure. Prolotherapy is therefore, successful because it strengthens weakened connective tissues, and relieves the pain of bone spurs.
Mesotherapy and Endotherapy (deeper injections with the same solutions) offer non-surgical alternatives to decreasing and eliminating the actual bone spurs, not just the pain of the bone spurs. By using compounds that affect calcium metabolism, such as EDTA, a calcium chelator, and Calcitonin, a calcium hormone, these treatments can successfully remove bone spurs over a period of time. Athletes commonly experience calcifications in structures such as the biceps and rotator cuff tendons. Mesotherapy and Endotherapy are useful treatments to employ when these structures are painful. These treatments will, over time, help the body rid itself of the abnormal physiology that led to the calcifications, thus, reducing their size and negative effects. Top Mesotherapy for Medical Esthetics Many Mesotherapists practice the specialty of Medical Esthetics because of the beautifying effects Mesotherapy has on the skin. The skin is often treated successfully with Mesotherapy. Wrinkles and cellulite respond well to Mesotherapy. The injections reach not only the different layers of the skin, but the subcutaneous fat as well, helping reverse the physiology that makes cellulite form. Top Cellulite Cellulite is a condition in which abnormal “nodules” of fat form in the midsection and thighs, more commonly in women than men. This gives the appearance of a ruffling of the skin. The condition is caused by abnormal physiology in the skin and subcutaneous fat. It involves a type of insufficiency in the venolymphatic system.
Mesotherapy injections are given to not only improve the venous and lymphatic flow, but to also break down the fat nodules. The solutions generally consist of a vasodilator, lymph flow stimulator, and an anesthetic. Because cellulite involves an abnormality in fat accumulation, Mesotherapy injections should be done in conjunction with a comprehensive natural medicine program designed to improve overall metabolism. This would have the effect of increasing weight loss and improving overall health. Hormone imbalances are often at the core of the problem and need to be corrected to have maximum benefits. If the underlying physiology is corrected and maintained, then Mesotherapy is done in an initial series. If it recurs, then the process will need to be repeated. Top Wrinkles Wrinkles, like other conditions involving the skin, have a multifactorial etiology. Excessive skin wrinkles or rides, can be caused by overall dehydration, excessive sun exposure, genetics, facial expressions, muscle atrophy, fatty acid deficiencies, hormone imbalances, nutrient deficiencies, and many other causes. As with cellulite treatment, it is best to utilize Mesotherapy for wrinkles in the context of a comprehensive natural medicine program to correct some of the above causes. For the person with stress and increased muscle contraction in the forehead, Botox injections can be given. Excessive wrinkles can also be a sign of advanced or aggressive aging, which emphasizes the need even more to utilize Mesotherapy, along side of a comprehensive Mid-Life Medicine regime. This may involve the use of regenerative therapies, natural hormone replacement, nutriceuticals, appropriate metabolic-type diet, and other Mid-Life Medicine measures. As with cellulite, Mesotherapy for wrinkles may often need to be repeated after the initial series. Top The Technique of Mesotherapy For those who have been fortunate enough to have Prolotherapy or Neural Therapy injections, you will be happy to know that the injections of Mesotherapy hurt magnitudes less than Prolotherapy or Neural Therapy. Mesotherapy injections involve extremely small needles that penetrate the body only a very small depth, which is typically four to six millimeters. Many of the needle sticks are not even felt because often times the skin is pinched by the clinician prior to and during the injections.
Mesotherapy treatments are typically given once per week. As improvement is seen, the treatments may be given less frequently, such as once every two weeks or once per month. If quicker improvement is necessary, such as an athlete desiring to resume athletic activities, treatments may be given twice per week. Mesotherapy can involve anywhere between eight and 300 shots, depending on the condition and amount of area covered. When more than 20 shots are given, it is typically because the person is getting multipricking or Mesolift done. Both of these Mesotherapy techniques involve very superficial, quick injections, taking less than a couple of minutes to do all of the injections, thereby maximizing the amount of area stimulated. This is often necessary for conditions such as cellulite, wrinkles, and hair loss, where a maximum area must be stimulated to produce a good result. The number of Mesotherapy treatments needed depends upon many variables, including the condition, the abnormal physiology causing the condition, as well as the chronicity of the problem. A minimum of three to five sessions of Mesotherapy are generally done to access response.
For long term chronic conditions such as cellulite and wrinkles, at least 15 sessions of Mesotherapy will be needed. For more acute conditions, such as sports injuries, only one to three sessions may be needed. (See Figure 3.) Top Figure 3: Nutritional Products to assist connective tissue healing. Item Ingredients Use Pro-Cartilage Ascorbic acid, Glucosamine, Chondroitin Sulfate, and Bromelain Aids soft tissue healing Pro-Collagen Vitamin A, Vitamin D3, Folic Acid, B-12, Biotin, PABA MSM, Nettles, Horsetail, Saw Palmetto, Fo Ti Root Support for hair loss; thinning, balding, dull or graying hair; and brittle nails ProloMax Potassium, Magnesium, Fo Ti Root, MSM, L-Proline, Siberian Ginseng, L-Cysteine, Horsetail, RNA, Gotu Kola, Activan, and Glucosamine. Support connective tissue growth,heal sports injuries, musculoskeletal pain, & after Prolotherapy. Skin & Nails Multi vitamin/mineral, L-Proline Silica, Burdock Root, Nettles, Gotu Kola, Dandelion Root, Milk Thistle, Grape Seed Connective tissue healing and promoting healthy skin and stronger nails Vita Vessel Horse Chestnut Butcher's Broom, Gota Kola, and Troxerutin Treat varicose veins blood clots, hemorrhoids, and overall blood circulation. GlucoBurn Citrimax Increase metabolismburn fat, and lose weight. Power Activator Pantothene, Iodine, Zinc, American Ginseng, Creatine, Lutien, Lipoic Acid, Prickly Ash, Cayenne Pepper, Siberian Ginseng, Tribulus Terrestris, Riboflavin Iincrease metabolism build strength, and lose weight Sports Doc Meal Replacement 14 grams soy protein plus vitamins and minerals. Meal replace-ment, protein supplement
Mesotherapy is a revolutionary alternative to liposuction, endermologie, plastic surgery and other invasive cosmetic procedures claiming to reduce fat and cellulite. Mesotherapy is a non-surgical, non-invasive injection therapy used successfully in treatments for cellulite reduction, weight loss, face and neck rejuvenation and body sculpting. Mesotherapy has excellent results when used in addition to, or in replacement of Botox and/or Restylane treatments for facial wrinkle reduction.
Mesotherapy is a cutting edge anti-aging injection technique that is performed by licensed health care clinicians. The mesotherapy treatment involves a microinjection of a customized mixture including vitamins, amino acids, and medications placed just millimeters under the skin into the problematic area. Just a “drop” of mesotherapy solution is used at each injection site.
Mesotherapy is a premier treatment offered by BioAge International. It is virtually painless, requires no post-operative recovery time, requires no bandages or girdles and no anesthesia is necessary. Bio Age Clinics have developed their own mesotherapy injection formula called Microinjection Therapy (MIT).
For Immediate Release: April 18, 2005
ARLINGTON HEIGHTS, Ill. – The allure of shedding unwanted pockets of fat with a series of simple injections, known as mesotherapy, sounds too good to be true - and it just might be. According to an ASPS Device & Technique Assessment (DATA) Committee report published in the April 15 issue of Plastic and Reconstructive Surgery® (PRS), the official medical journal of the American Society of Plastic Surgeons (ASPS), patients should be wary of mesotherapy until the safety and effectiveness of the procedure are confirmed.“The promise of a non-surgical, permanent method for fat removal and body contouring is obviously very appealing, but mesotherapy is not proven to be the miracle cure to a thinner you,” said Alan Matarasso, MD, study co-author. “The problem with mesotherapy is the whole technique is shrouded in mystery. Liposuction remains the only proven method to safely and permanently remove fat.”Touted as a non-surgical alternative to liposuction, mesotherapy involves injecting medications and plant extracts into layers of fat and connective tissue under the skin. The injected ingredients may include agents that are used to open blood vessels, non-steroidal anti-inflammatory medications, enzymes, nutrients, antibiotics and hormones. Mesotherapy may be used in conjunction with dietary modification, hormone replacement therapy, exercise and nutritional supplements. No drug is approved by the U.S. Food and Drug Administration for use in mesotherapy.Although the practice of mesotherapy has been around for decades in Europe, it has only recently been introduced in the United States. There are no published scientific studies demonstrating if the effects are permanent, why or if certain ingredients work, or how safe mesotherapy is for patients. In addition, there is no standardization in mesotherapy. The types of drugs used vary from physician to physician as does the quantity and frequency of injections.MesotherapyMesotherapy may cost $1,000 to $1,500 per treatment with three to six treatments required. This can prove costly for patients who may not receive the desired results.“Plastic surgeons are constantly researching better methods to help patients achieve their desired look; however, patients’ health and safety is always foremost on our minds,” said Dr. Matarasso. “There is no information on what happens to fatty acids once they leave the targeted area or how the various ingredients affect the body’s organs and other tissues. There is simply too much we do not know about mesotherapy to say it is unquestionably safe for patients.”Currently, liposuction is the only method that has been proven to safely and effectively remove fat. According to ASPS statistics, liposuction was the most popular cosmetic surgical procedure in 2004, with more than 325,000 procedures performed.“Without data to support claims that mesotherapy works, the procedure appears to be a mystic type of therapy,” said Susan Kaweski, MD, ASPS DATA Committee chair. “The DATA Committee has not seen any long-term studies that would prove mesotherapy actually removes fat from the body. We need to know a lot more about this procedure before plastic surgeons can endorse mesotherapy and recommend it to patients.”
The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. With more than 5,000 members, the society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the society represents physicians certified by
Jäger C, Brenner C, Habicht J, Wallich R.
ATOS Clinic Heidelberg, Bismarckstr, Heidelberg, Germany Institute for Immunology, University Clinics Heidelberg, Heidelberg, Germany.
The promise of mesotherapy is maintenance and/or recovery of a youthful skin with a firm, bright and moisturized texture. Currently applied medications employ microinjections of hyaluronic acid, vitamins, minerals and amino acids into the superficial layer of the skin. However, the molecular and cellular processes underlying mesotherapy are still elusive. Here we analysed the effect of five distinct medication formulas on pivotal parameters involved in skin ageing, that is collagen expression, cell proliferation and morphological changes using normal human skin fibroblast cultures in vitro. Whereas in the presence of hyaluronic acid, NCTF135(®) and NCTF135HA, cell proliferation was comparable to control cultures; however, with higher expression of collagen type-1, matrix metalloproteinase-1 and tissue inhibitor of matrix metalloproteinase-1, addition of Soluvit(®) N and Meso-BK led to apoptosis and/or necrosis of human fibroblasts. The data indicate that bioactive reagents currently applied for skin rejuvenation elicit strikingly divergent physiological processes in human skin fibroblast in vitro.