Phospholipids do not have lipolytic activity. A critical review

The efficacy of high-frequency ultrasound-guided injection lipolysis in reducing fat deposits located on the inside of the knees

Introduction

Many women consider local fat deposits unacceptable for aesthetic reasons as they have negative impact on appearance and thus, contribute to reduced self-esteem. Injection lipolysis (intralipotherapy) may be an alternative for conventional liposuction in reducing fat deposits.

Aim

The aim of this paper was to assess the efficacy of high-frequency ultrasound-guided injection of deoxycholic acid (intralipotherapy) to remove fat deposits on the inner side of knees.

Materials and methods

The procedure was performed in 7 women (14 inner sides of knees). The formulation was administered under high-frequency ultrasound guidance. The procedure was performed twice at 4-week intervals in each patient. High-frequency ultrasound guidance was used to monitor such parameters as the thickness of the dermis (DermaMed, Dramiński S.A.) or the subcutaneous tissue (Philips Epiq 5, USA). Ultrasound was performed both before and after treatment. Additionally, anthropometric measurements were taken, a questionnaire was performed, and a photographic documentation was recorded.

Results

Reduction in knee circumference and subcutaneous tissue occurred in 71.42% of patients.

Conclusions

Intralipolysis with deoxycholic acid formulation is an effective method for reducing fat deposits on the inner part of the knees. Ultrasonography proved to be a useful method to monitor the procedure (correct administration of the preparation) and to assess treatment outcomes. A small sample size was a limitation of our study; therefore further studies are needed.

A New Treatment for Local Adiposity with Ascorbic Acid and Ascorbyl-Palmitate Solution: Clinical and Histological Study

Background

Localized adiposity (AL) is the accumulation of subcutaneous adipose tissue, placed in definite anatomic areas, building up an alteration of the body silhouette. The aim of the present clinical and histological study is to assess the effectiveness of an injectable solution containing sodium salt of ascorbic acid 0.24% and surfactant agent at 0.020% ascorbyl-palmitate (SAP) for treating local adiposity.

Methods

Eighty healthy female adult patients were selected, suffering from local adiposity in the abdominal region. The patients underwent a cycle of 6 sessions, with biweekly treatments, without the addition of any active ingredient. Direct infiltration of pharmacologically active SAP solutions into the adipose tissue with a long needle, very similar to the needles used for spinal anesthesia, was performed. This procedure is quick and painless (does not require any anesthesia) with moderate infiltration speed.

Results

All the patients treated showed good results with good satisfaction of the circumferential reductions. Before treatment: Waist (cm) 78.8 ± 10.6 and hip 93.6 ± 9.0 with WHR 0.84 ± 0.07. After treatment: Waist (cm) 70.8 ± 9.6 and hip 92.6 ± 8.0 with WHR 0.76 ± 0.06. Indeed, signs of adipocyte apoptosis were observed in subcutaneous skin after injection of SAP.

Conclusion

The results showed in the present study suggest that the SAP utilized induces apoptosis of adipocytes and could be of use as a safe and effective method with which to eliminate subcutaneous abdominal fat.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Evaluation of Safe and Effectiveness of an Injectable Solution Acid Deoxycholic Based for Reduction of Localized Adiposities

Background:

The use of deoxycholic acid to reduce localized fat deposits is a procedure that has been in use for about 30 years. Its effectiveness as treatment is due to emulsification of phospholipids and therefore, solubilization of the biological membranes with resulting fat necrosis. The purpose of the study was to assess the effectiveness and the safety of an injectable solution containing sodium deoxycholtate 1.25% (DB125), used as intralipotherapy.

Methods:

The effectiveness and safety of DB125 solution have been assessed with a multicentre observational prospective study carried out between February and October 2017. The 221 selected patients presented with various forms and degrees of localized fat in several areas. Intralipotherapy treatments were performed 6 weeks apart and until the clinical result was obtained. Aesthetic outcomes were evaluated by the authors using preoperative and postoperative photographic documentation and by the patients with their level of satisfaction by filling out an anonymous form. Major adverse events were reported by each doctor who performed the treatment.

Results:

Two hundred twenty-one patients treated in 273 cases of different localized fat deposits. One hundred eighty-five patients who could be assessed for final results gave the effectiveness of the treatment an average score of 7.4. The failure percentage of the treatment was 3.8%. The medical evaluation showed treatment success in 93.5% of cases. Adverse events can be divided into 2 groups: minor adverse events, which are very frequent and major ones, which are extremely rare. For both groups, the adverse events can be ascribed to localized problems in the treatment area.

Conclusion:

Studies have shown that the second-generation solution containing sodium deoxycholate 1.25% is effective and safe to treat different localized fat deposits. The high degree of effectiveness shown in the study was not associated with a lesser degree of handling because, at the doses indicated and with the use of intralipotherapy, the occurrence of adverse events was minimal.

Lipoma removal using a high-frequency ultrasound-guided injection of a Class III CE-marked device-Empirical findings

BACKGROUND

Lipomas are very common benign neoplasms, which constitute 99% of all adipose-derived tumors. Main treatment option includes surgical excision, which is unacceptable for a number of patients seeking ways to improve esthetic appearance of their skin. Therefore, alternative treatment options are being sought.

OBJECTIVE

The aim of the present study was to assess the efficacy of lipoma removal using a Class III CE-marked device (Aqualyx™) administered as a high-frequency ultrasound-guided injection (intralipotherapy).

METHODS

A total of 17 lipomas were treated. The procedure involved a high-frequency ultrasound-guided injection. A maximum of 3 injections per a lipoma were performed. High-frequency ultrasound was used for assessing the size of lipomas and monitoring treatment-induced changes to the lipomas and adjacent tissue.

RESULTS

Response to treatment was achieved in all cases. A complete removal was achieved in 70.59% of lipomas. The remaining 29.41% of lipomas were not completely removed, yet significantly reduced in size.

CONCLUSION

An injection of Aqualyx™, a CE-marked drug, is a good noninvasive treatment of lipomas. Ultrasound guided procedure is recommended, as it ensures appropriate technique and enables monitoring treatment-induced changes. Considering a low number of published reports of such treatment, it is crucial to continue this research.

Intralipotherapy, the State of the Art

Background:

Reconstruction intralipotherapy is a term commonly used in the field of aesthetic medicine, above all in Europe, which defines a specific injection technique developed for the treatment of localized fat with substances that provoke the lysis of adipocytes by means of an injection directly into the adipose tissue with a long needle. The aim of this study is to define the technique in detail and everything that is associated with it, on the basis of years of multicenter experience by doctors who perform it.

Materials and Methods:

From January 2010 to December 2014, 3,080 European physicians were trained in intralipotherapy technique, and approximately 152,500 patients were treated. The adipocytolytic agent used is a Conformité Européene-certified device. The technique, equipment, protocol, posology, postoperative management, and adverse events are described below.

Results:

The intralipotherapy technique combined with the appropriate adipocytolytic agent has been shown to be effective in every zone on the average of 76.7% of the cases. The variability is due to the area treated and the patient. The standardization of the technique, homogeneity of the protocol, and the posttreatment management have been essential for standardizing the results and minimizing any adverse events. The latter occurred only in a small percentage of the cases, while those more serious have been extremely rare.

Conclusion:

This study shows how the intralipotherapic technique, when performed properly with an appropriate adipocytolytic device and when proper precautions are taken, can be effective and safe for reducing undesirable subcutaneous fat deposits.

Local fat treatments: classification proposal

The poor understanding of the real, intimate action mechanisms behind any aesthetic procedures is a huge problem for many Aesthetic physicians. In addition, nomenclature of and regarding any procedure has become a true barrier when speaking about medical knowledge in the Aesthetic Medicine field since marketing and science often collide one another. Medical procedures for localized fat reduction are very different from each other and it is, at least, inaccurate to refer to all of them plainly as "fat reduction methods." A specific classification has become urgent and its categories should be able to imply what each method entails. For this classification proposal, "reversibility," "membrane disruption or inflammation," and "action selectivity," have been the selected criteria.

A CE-Marked Drug Used for Localized Adiposity Reduction: A 4-Year Experience

BACKGROUND

Injectable fat-reducing therapies are not an alternative to liposuction. Rather, they may be best suited for patients who are unwilling or unable to undergo surgical reduction of small collections of fat, and for patients who desire touchups for liposuction-induced irregularities.

OBJECTIVES

The authors report their 4-year experience with a novel injectable CE-marked drug, used in an off-label manner.

METHODS

Between October 2009 and November 2013, 186 patients were treated by injection of an adipocitolytic solution in 1 of 4 private Italian aesthetic facilities, by 1 of 4 independent physicians. Treated areas included the neck, hips/saddlebags, abdomen/love handles, inner thighs, and buffalo hump. Complications and side effects were documented.

RESULTS

All patients experienced mild to moderate swelling and reddening of the skin, which resolved 3 to 5 days after injection. No major complications or side effects occurred, such as necrosis. Rates of transient events were as follows: hematoma, 1.61%; paresthesia, 1.07%; and ecchymosis, 6.45%. Pruritus was reported by 21.5% of patients, which began 3 to 7 days following injection. Subcutaneous nodules were noted in 1.61% and resolved within 4 months of injection. A transitory "unusual sensation" was reported by 12.9% of patients, which lasted up to 2 months after final injection.

CONCLUSIONS

Results demonstrate that this CE-marked agent appears to be effective and safe for medical treatment of fat reduction.

[Injection lipolysis]

A new treatment variation in the spectrum of aesthetic medicine has been investigated worldwide since 2004: so-called injection lipolysis. Advances in knowledge regarding the efficacy and mechanism of action have been achieved especially in Germany because most users are found in Germany when compared on an international level. The reason for this is that the combination of phosphatidylcholine and deoxycholic acid as active substances has been approved for i.v. treatment of fat embolisms. It is thus readily available, but the subcutaneous injection of the drug Lipostabil N® is considered as off-label use. Meanwhile injection lipolysis has become an integral component for many in the practice of aesthetic medicine. The international association of physicians performing lipolysis in the so-called NETWORK-Lipolysis (with more than 2,000 members worldwide) has in particular called for the development of internationally recognized treatment standards and protocols. When the indication for its use adheres to strict criteria and the physicians applying the method have participated in intensive training, subcutaneous injection of phosphatidylcholine/deoxycholic acid represents a meaningful addition to the scope of minimally invasive aesthetic medicine.