lipodissolve clinical studies

Lipodissolve for Body Sculpting
Safety, Effectiveness, and Patient Satisfaction


Lipodissolve for Body Sculpting

Safety, Effectiveness, and Patient Satisfaction

KHALID MAHMUD, MD, FACP; CHARLES E. CRUTCHFIELD III, MD 

Innovative Directions in Health, Edina Minnesota; University of Minnesota, Minneapolis, Minnesota; Crutchfield Dermatology, Eagan, Minnesota

ABSTRACT

Lipodissolve, to reduce superficial deposits of fat, has gained popularity in recent years. A simple solution of phosphatidylcholine in deoxycholate evolved around 2004 and has been used by two collaborating physicians in Minnesota. Their experience encompassing 1,616 patients receiving a total of 15,122 treatments is described. Relatively modest volumes of injections produced satisfactory and smooth results in 74.5 to 86.5 percent of the patients in the two practices. No serious complications developedMinor and rare side effects included pain, lightheadedness, tender nodules, pigmentation, and ulceration in two patients. The authors offer useful tips to enhance safety, effectiveness, and patient satisfaction with the procedure. (J Clin Aesthet Dermatol. 2012;5(10):16-19.)

Localized injections of phosphatidylcholine (PC) with deoxycholate (DC) to reduce superficial deposits of fat have gained popularity in the United States since the turn of the century. Initially, different practitioners added multiple other ingredients, including L-carnitine, aminophylline, collagenase, various vasodilators, and hyaluronidase. A standard formula with PC and DC as essential ingredients was then introduced in Europe and adopted by the American Society of Aesthetic LipoDissolve (ASAL) in the United States around 2004. Since then, several hundred physicians in the United States have treated thousands of patients.

The mechanism of action of the mixture is similar to that of bile, wherein DC (a bile salt) breaks down the ingested fat cells, and PC assists the digestion and drainage of released fat,1 but mostly protects the neighboring mucosa from the corrosive action of DC.2–4 It has been shown that when injected in subcutaneous fat, DC alone leads to adipocyte death5; however, there is less pain, bruising, and induration when combined with PC.6 Once the fat cells are destroyed, they are slowly removed by the macrophages (foam cells) in the concomitant inflammatory response,7 resulting in fat reduction in the treated area, while at the same time newly laid down collagen tightens the overlying skin. The techniques, efficacy, and side effects of lipodissolve have been the subject of several reports over the past five years.

The following is a report of 1,616 patients who received 15,122 treatments of lipodissolve during the last 6 to 7 years by two Minnesota physicians who were a part of the ASAL. The results are described herein, followed by useful tips to enhance safety, efficacy, and patient satisfaction.


AREAS TREATED

Abdomen, flanks, outer thighs (saddle bags), posterior upper thighs (banana roll), and anterior thighs (mostly cellulite) were the most common areas treated. Back, arms, and chin/jowls were less common.


METHODS

The areas were marked by palpating exact outlines. For example, the abdomen was not injected as a whole, but as separate areas over the upper, lower, or periumbilical abdomen, which were marked exactly. Saddle bags were marked according to exact shape and extended to banana rolls, if necessary. Icing the area for 4 to 5 minutes seemed to reduce immediate stinging and pain and was used for most of the patients at one clinic. PC/DC injections were placed 1.5cm apart and at a depth of the middle of the fat pad and slightly more superficially in cases of cellulite to provide better skin tightening. The volume of the solution (PC 25mg/mL, DC 21mg/mL) varied from 20 to 30cc per flank or saddle bag to 40 to 60cc per abdominal area in the two different practices. A few double chins were treated with 3 to 6cc. Ultrasound, for a few minutes, was added before or after injections for the possibility of improved adipocyte lysis.

TABLE 1. Cumulative results

RESULTS

PRACTICE A [60mL AVERAGE/Rx]

PRACTICE B [40mL AVERAGE/RX]

Treatments per area

3

4

Patient satisfaction

86.6%

74.4%

Significant pain for up to three days leading to

discontinuation

1.4%

1%

Significant dizziness leading to discontinuation

2.1%

1.5%

Residual pigmentation

1.4%

1.3%

Tender nodules lasting more than two months

1.6%

1.1%

Ulceration

0.39% (2 patients)a

None

Hives

0.39% (2 patients)b

None


a-One patient had a previous diagnosis of Lupus (not disclosed to the authors) and received 40cc of the solution to each saddle bag. The other with upper inner thigh injections (30cc each side) had been walking with rubbing of the injected areas.

b-Both of these patients had undisclosed soy allergy (usual PC/DC solution is soy based).


RESULTS

When response could be easily measured, such as abdominal circumference reduction in 95 patients, it varied from 0.125 to 3 inches per treatment, with an average of 1.1 inch. The fat reduction was generally associated with some degree of skin tightening, resulting in a smooth appearance. No patient developed lumpy, bumpy, or uneven appearance, as seen in some patients after liposuction. Complications were minor and extremely rare and developed in 1 to 2 percent of the patients (Table 1). Lightheadedness from hyperventilation, pain, and prolonged tender nodules were slightly more common in patients receiving a higher volume of injections (practice A). Complications of liposuction, such as pulmonary embolism, hemorrhage, perforation, lidocaine/epinephrine toxicity, third space fluid shifts, and fat embolism,13,14 did not occur with lipodissolve.


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REFERENCES

1. Tso P, Kendrick H, Balint JA, et al. Role of biliary phosphatidylcholine in the absorption and transport of dietary triolein in the rat. Gastroenterology. 1981;80(1):60–65.
2. Tsuboi K, Tazuma S, Nshioka T, et al. Partial characterization of cytoprotective mechanisms of lecithin against bile salt-induced bile duct damage. J Gastroenterol. 2004;39(10):955–960.
3. Barrios JM, Lichtenberger LM. Role of biliary phosphatidylcholine in bile acid protection and NSAID injury of the ileal mucosa in rats. Gastroenterology. 2000;118(6):1179–1186.
4. Eros G, Kaszaki L, Czobel M, et al. Effects phosphatidylcholine pretreatment during acute experimental biliary reflux. Magy Seb. 2005;58(6):406–414.
5. Rotunda AM, Suzuki H, Moy RT, et al. Detergent effects of sodium deoxycholate are a major feature of an injectable phosphatidylcholine formulation used for localized fat dissolution. Dermatol Surg. 2004;30(7):1001–1008.
6. Salti G, Ghersetich I, Tantussi F, et al. Phosphatidylcholine and sodium deoxycholate in the treatment of localized fat: a double-blind, randomized study. Dermatol Surg. 2008;34(1):60–66.
7. Rose PT, Morgan M. Histological changes associated with mesotherapy for fat dissolution. J Cosmet Laser Ther. 2005;7(1):17–19.
8. Palmer M, Curran J, Bowler P. Clinical experience and safety using phosphatidylcholine injections for the localized reduction of subcutaneous fat: a multicentre, retrospective UK study. J Cosmetic Derm. 2006;5:218–226.
9. Duncan DI, Chubaty R. Clinical safety data and standards of practice for injection lipolysis: a retrospective study. Aesthetic Surg J. 2006;26(5):1–12.
10. Duncan DI, Palmer M. Fat reduction using phosphatidylcholine/sodium deoxycholate injections: standard of practice. Aesth Plast Surg. 2008;32:858–872.
11. Silberg BN. The technique of external ultrasound-assisted lipoplasy. Plast Reconstr Surg. 1998;101:552.
12. Hoefflin SM. Lipoplasty with hypotonic pharmacologic lipo-dissolution. Aesth Surg J. 2002;22:573–576.
13. Toledo LS, Mauad R. Complications of body sculpture: prevention and treatment. Clin Plast Surg. 2006;33(1):1–11, V.
14. Platt MS, Kohler LJ, Ruiz R, et.al. Deaths associated with liposuction: case reports and review of the literature. J Forensic Sci. 2002;47(1):205–207.
15. Masella L, Viscdi E, Buffardini G, et al. Polyunsaturated phosphatidylcholine in pulmonary fatty microembolism in patients with multiple fractures. Clin Ter. 1983;105(1):13–22.
16. Klimov AN, Konstantinov VO, Lipovestsky BM, et al. Essential phospholipids versus nicotinic acid in the treatment of type 2 hyperlipoproteinemia and ischemic heart disease. Cardiovasc Drugs Ther. 1995;9(6):779–784.
17. Jimenez MA, Scarino ML, Vignolini F. Evidence that polyunsaturated lecithin induces a reduction in plasma cholesterol and favorable changes in lipoprotein composition. J Nutr. 1990;120(7):659–667.
18. Lombard E, Marin V, Domingo N, et al. Anionic peptide factor/phosphatidylcholine particles promote the inhibition of vascular cell adhesion molecule-1 in human umbilical vein endothelial cells. Pathobiology. 2005:72(4):213–219.

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