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Fat-Dissolving Injections?

The “Skinny” on LipoDissolve

 

Whitney Gower

September 24, 2007

 

 

 

            It seems that everywhere you look on Vanderbilt’s campus, you see beautiful, skinny people.  With the enormous social and cultural pressure to be thin, it’s no wonder that today’s women and men are going to great lengths to obtain the “perfect” figure.  While some achieve these results with diet and exercise, cosmetic procedures are a well-established way to obtain noticeable results, and more and more people are going under the knife every year for their dream body.  The American Society of Plastic Surgeons reports that almost 11 million cosmetic procedures were performed in 2006, which represents a 48% increase in the number of procedures since 2000.  While this trend may seem obvious and inevitable, a more interesting fact is that the percent of surgical procedures actually dropped during the 6-year period mentioned, while the percent of minimally-invasive procedures, such as Botox and cellulite treatments, increased dramatically (http://www.plasticsurgery.org/media/statistics/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=23628).  One of the newest and most popular cosmetic procedures available is LipoDissolve.  A company that specializes in the procedure describes LipoDissolve as a “series of injections to remove localized fat deposits” (http://www.fig.com/mythvfact.html).  While shots that get rid of fat sound too good to be true, LipoDissolve providers offer extensive patient testimonials and results to back their claims. 

 

“Proven Results:” Claims from the Providers

           

            Given that the population is becoming increasingly overweight, it comes as no surprise that more and more people are looking for a solution to their weight problems.  However, most lack the financial resources, and the courage, to go through with a surgical procedure such as liposuction.  LipoDissolve offers another alternative: a series of non-invasive shots that dissolve targeted fat cells.  In other words, they are removing fat without involving expensive surgery and an extended recovery period.   LipoDissolve can be performed on many areas of the body, such as the chin, arms, abdomen, thighs, and back.  Many providers promise inch loss – as opposed to weight loss – with some going as far as saying, “it’s not a question of whether LipoDissolve will work, but rather how many treatments it will take to attain a goal in reduction” (http://www.bluemedspa.com/lipodissolve.php).   Results are also touted as permanent; because the treated fat cells are dissolved, they are gone for good.  However, new fat cells can grow in the treated area if the patient experiences significant weight gain after the injections.  LipoDissolve providers also claim that patients will not experience loose or saggy skin around the treatment area; in fact, the solution used in the procedure can improve elasticity and cause the skin to tighten (http://www.fig.com/mythvfact.html).  And because the procedure is non-invasive, patients can return to normal activities almost immediately.  The procedure has been called “Lunchtime Lipo” because many patients can have treatments in less than an hour and return to work the same day.  With claims like these, it is no wonder that LipoDissolve facilities are popping up across the country. 

 

The Miracle Solution: How LipoDissolve (Supposedly) Works

 

            It has already been stated that LipoDissolve consists of injections that target fat cells.  But what exactly is being injected, and how does it work?  While some are calling LipoDissolve a form of mesotherapy, others are adamantly against the application of that term.  Mesotherapy is a combination of vitamins, minerals, and medications injected into the skin to treat several different conditions (http://www.abameso.org/what.php).  LipoDissolve differs because most providers do not use vitamins and minerals in their solutions.  Most include phosphatidylcholine and deoxycholate, two compounds that occur naturally in the human body.  The phosphatidylcholine used in LipoDissolve solution is often derived from soy, and the deoxycholate that is often used is a bovine-derived bile salt.  The solution is produced in compounding pharmacies and then shipped to the clinics, where it is administered (http://www.medsculpt.com/FAQs/default.aspx).  The administered solution is taken up by the target fat cells, and causes lysing of the cells.  The waste created by the breakdown of the cells is transported through the bloodstream to the kidneys, where it is filtered out and excreted with the body’s natural waste products.  The solution also stimulates collagen formation, which helps to tighten the skin once the fat cells have dissolved (http://www.oceanclinics.com/lipo-dissolve.html).  LipoDissolve providers also claim an excellent safety record.  When appropriately used, there have been no reports of long-term adverse effects from the procedure (http://www.fig.com/mythvfact.html).

 

The Downside: Risks and Warnings

 

            While LipoDissolve providers supply first-hand reports of the procedure’s success, there are others who are cautious.  The solutions used in LipoDissolve, while containing the same major ingredients, differ in the amount of each per injection.  Some also add numbing agents to the solution to lessen discomfort.  This means that there is no standardized solution for LipoDissolve, and side effects can vary greatly due to the differences in solution.  Also, the phosphatidylcholine deoxycholate compound has not been approved for use by the FDA, and approval is not being sought by the companies that produce the drug.  This is legal because the components have been approved for the FDA for other uses, and not specifically prohibited for use in LipoDissolve compounds (http://www.surgery.org/press/news-release.php?iid=370).  However, due to the recent upsurge in popularity of the LipoDissolve procedure, the FDA is now investigating the procedure and the use of the phosphatidylcholine deoxycholate compound.  There have also been complaints of nausea, pain, and extreme swelling at injection sites (http://www.usatoday.com/news/health/2007-09-10-lipodissolve_N.htm?csp=34).  For these reasons, it is important to delve into the studies concerning LipoDissolve and try to find the truth about the effectiveness and safety of procedure.

 

Medically Proven?: What the Studies Say

 

            A study performed by Duncan and Hasengschwandtner (2005) followed 43 patients between October 2004 and May 2005.  These patients were injected at a total of over 110 sites based on treatment protocol of the American Society for Aesthetic Lipodissolve.  The study focused on whether the LipoDissolve formula and injection technique was successful in both fat reduction and retention of skin elasticity at the injection site.  They found that 13 of the 43 participants saw dramatic improvement of localized fat deposits, and 29 reported mild to moderate improvement, leaving only one participant with almost no response to the treatment. 

            The authors of the study also performed injections on abdominoplasty specimens to determine where the solution settles, and if migration of the solution to surrounding tissue could cause damage.  They found that the dispersion did occur on varying levels, depending on the depth of the injection as well as needle length and gauge. 

            They concluded that LipoDissolve was effective in decreasing the thickness of fat deposits, and that skin retraction accompanied these results at the injection sites.  It was noted that the level of success and happiness with the procedure depends on a variety of factors, including proper formula and proper injection technique.  Maximal results were obtained in participants who were already close to an ideal healthy weight, where the injections were focused on a small localized fat deposit.  The authors of the study cautioned that adjacent non-fat tissue could be adversely affected if poor injection procedures were utilized.

            Another study performed by Hasengschwandtner (2006) followed 441 patients who each underwent a series of one to four LipoDissolve treatments.  The circumference of the treated area was measured before each treatment and again 8 weeks after treatment.  Participants were asked to refrain from dieting during the study so as to limit the chance that any change in fat deposits was a result of outside weight loss. 

            Fat loss was measured by a reduction in the circumference of the treated area, and varied depending on which area was treated.  The average loss for the abdomen was 3.8 cm (1.5 in), for the hip area was 1.9 cm (0.7 in) and for the arms was 1.6 cm (0.6 in).  Figure A shows the visible results achieved in one participant from the study.  Most participants were satisfied with results after two treatments, with only 2% requesting all four treatments.  It was concluded that the LipoDissolve procedure was an effective alternative to liposuction in patients with small fat deposits, although a small percentage did not respond to the procedure as well as most.  It was indicated that hypothyroidism or abnormal hormone levels may adversely affect the success of the treatments.  The author was careful to point out that patient selection was key for maximal results, stating that younger patients responded better.  It was also suggested that the procedure be considered not as an alternative to liposuction, but a tool to enhance cosmetic results of surgery. 

 

 

Fig. A:

Pre- and post-treatment views of a 57 year old woman who received one treatment. 

From Hasengschwandtner (2006) study.

 

            A third study, by Chubaty and Duncan (2006), addressed the issue of clinical safety among LipoDissolve providers.  The authors of the study surveyed 75 physicians who had collectively treated over 17,000 patients about the treatment areas, complications, and side effects.

            There were 5 areas that were reported as responding well to treatment by over a third of the providers surveyed.  These areas include the abdomen, flanks, chin, back, and outer thigh.  It was noted that the inner thigh and knees did not respond favorably in a majority of patients, and adequate results depended heavily on the age of the patient, the amount of localized fat, and skin laxity.  It was also noted that firm, fibrous fat did not respond well to treatment in any body area. 

            Complications following the treatment were found to be rare; no patients were hospitalized or died following treatment.  Persistent pain two weeks post-treatment was noted in 4% of participants, with less than a 0.015% incidence.  Most providers (77.2%) noted that they had a less-than-adequate response from at least one patient, but the incidence of total non-response was less than 1%.  There were several factors that were noted as possibly affecting the non-responders, including obesity, hypothyroidism, and large areas of firm, fibrous fat. 

            Redness, swelling, and bruising were noted in at least 70% of patients post-treatment, but most side effects were transient and occurred within 24 hours of treatment.  Only 20% of providers noted that their patients complained of significant pain at some point during or following treatment.  Figure B shows the incidence of pain as a factor of time following treatment.  This figure shows that pain seemed to peak within an hour of treatment, followed by another peak at 24 hours post-treatment.  The incidence of participants reporting pain one week post-treatment was extremely small (less than 1%).

            It was concluded that the LipoDissolve procedure is best used to treat small, localized fat deposits.  The procedure seemed safe, as no severe complications developed as a result of the treatment.  It is important to note that this study relied on reporting by the treatment provider, rather than the actual patient.  This could cause complications as the provider may not have complete or accurate information regarding all of their patients; they could only report what they were told by the patient.

 

Fig. B:

 

Pain incidence as a function of time following treatment.

From Chubaty & Duncan (2006) study.

 

 

Putting It All Together

 

            In the rapidly expanding world of cosmetic procedures, LipoDissolve seems to be the newest “quick-fix” non-surgical treatment for those that want to get rid of some unsightly lumps.  However, it should be noted that LipoDissolve is by no means a quick and painless way to achieve the perfect figure.  Studies indicated that maximal results were not obtained until months following treatment, and side effects such as pain, redness, and swelling were common among patients.  While there seemed to be a high success rate in the studies, not much research pertaining to the specific treatment course could be found.  This indicates that there may not be enough information available at this point in time to determine the true effectiveness of the procedure.  Also, the studies found were all very recent, having been completed within the past two years.  The lack of long-running studies makes it hard to understand the long-range consequences and complications involved with the procedure.  It should also be noted that maximal results depended highly on patient selection; younger, healthier patients showed better results than any other patient group, and individuals investigating the treatment should understand that fact and temper their expectations accordingly.  And though the components generally used in LipoDissolve compounds have been tested for use and approved by the FDA, patients should investigate the specific formula ratio and injection technique of their provider, as those factors have been shown to greatly influence results. 

 

 

Literature Cited:

 

Chubaty, R., & Duncan, D.I. (2006). Clinical safety data and standards of practice for     injection lipolysis: A retrospective study. Aesthetic Surgery Journal, 26, 575-585.

 

Duncan, D.I., & Hasengschwandtner, F. (2005). Lipodissolve for subcutaneous fat         reduction and skin retraction. Aesthetic Surgery Journal, 25, 530-543.

 

Hasengschwandtner, F. (2006).  Injection lipolysis for effective reduction of localized fat           in place of minor surgical lipoplasty. Aesthetic Surgery Journal, 26, 125-130.

 

Additional Resources:

 

American Society for Aesthetic Plastic Surgery (2004). Lipoplasty (Liposuction) Without             Surgery Update. Retrieved September 21, 2007 from     http://www.surgery.org/press/news-release.php?iid=370.

 

American Society of Plastic Surgeons (2007). 2000/2005/2006 National Plastic Surgery             Statistics.  Retrieved September 20, 2007, from       http://www.plasticsurgery.org/media/statistics/loader.cfm?url=/commonspot/secur      ity/getfile.cfm&PageID=23628

 

Lipodissolve (n.d.). Retrieved September 21, 2007 from          http://www.oceanclinics.com/lipo-dissolve.html.

 

Lipodissolve FAQs (n.d.). Retrieved September 20, 2007, from             http://www.bluemedspa.com/lipodissolve.php.

 

MedSculpt FAQs (n.d.). Retrieved September 20, 2007 from             http://www.medsculpt.com/FAQs/default.aspx.

 

Myth vs. Fact (n.d.). Retrieved September 20, 2007, from        http://www.fig.com/mythvfact.html.

 

Rubin, R. (2007, September 10). Lipodissolve proves popular despite lack of FDA nod. USA Today. Retrieved September 21, 2007 from        http://www.usatoday.com/news/health/2007-09-10-lipodissolve_N.htm?csp=34.

 

What is Mesotherapy? (n.d.). Retrieved September 20, 2007 from     http://www.abameso.org/what.php .

 

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