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Right across the street from my office on Wilshire Blvd. there is a large sign that reads: "Instant facelift. No downtime, no cutting, no surgery. Mesotherapy works."

Having practiced cosmetic surgery and dermatology for over 10 years, I have yet to see any significant or lasting improvement caused by the injection of Vitamins or herbal extract. A recent study by Dr. George J. Hruza published in the December issue of Dermatological Surgery (Dermatol Surg 2006 Dec;32:1467-72) shared this view. The study concludes that injections of Vitamins and herbal extracts do not result in any clinically relevant benefit. Aside from subcutaneous injections of Phosphatidyl choline and deoxycholate for lipolysis, mesotherapy continues to show a lack of clinical efficacy while still subjecting patients to potential risk.

Without a compelling study to the contrary, I am reluctant to endorse Mesotherapy as an effective and safe form of treatment. Perhaps more studies similar to Dr. Hruza's will be available in the future to shed more light on the efficacy of these and other commonly used rejuvenation techniques.

Cosmetic surgery inherently involves some level of risk. On occasion, one can encounter rare symptoms such as bleeding, infection, or scars that just won't heal right--all symptoms that can complicate the recovery for months to come. When considering cosmetic surgery, it is important to factor in these unpleasant risks, so that you are equipped to handle them should they arise.

Last year I was asked to consult on a patient who had undergone a facelift procedure in Mexico. The immediate post-operative period had been uneventful, and she had returned to Los Angeles to recover. Four weeks after the surgery the scars in front of her right ear started to thicken. Over the next few months, these scars developed into unsightly and painful Keloids, which required several corrective treatments. . .

A few weeks ago I was asked to evaluate a patient with irregular fat deposits resulting from a fat transfer. She had undergone repeated fat transfers into the lips, cheeks, and nasolabial folds with less than perfect results.

Although the transferred fat had been applied relatively regularly, the ensuing hematoma (bleeding/bruising) had resulted in a significant shift of the applied fat and deep scarring.

All things being equal, Fat Transfer is very successful; however infections, seroma formation (collection of fluid under the skin) and irregular absorption of the fat can lead to a lumpy appearance.

Solution: Once again, we need to use a comprehensive approach to correct this problem. I usually start by breaking the excess fat and scarring down with repeated intralesional cortisone shots (ILTAC 2.5mg/cc). This is followed by subsicion of the deep fibrous bands, and lymphatic drainage. Finally, the excess fat can be gently suctioned by hand.