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Alizadeh Z, Halabchi F, Bodaghabadi Z, Zarandi MM, Abolhasani M, Seifi V, Khazaei R, Ghanadi S, Mazaheri R, Tabesh MR. Non-invasive Body Contouring Technologies: An Updated Narrative Review. Aesthetic Plast Surg 2024; 48:659-679. [PMID: 37749418 DOI: 10.1007/s00266-023-03647-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/29/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION Nowadays, a lot of body contouring devices and methods are introduced all over the world. The object of the present narrative review was to update and classify existing evidence on these methods and devices. METHODS We searched databases including PubMed, Cochrane, and Google Scholar for 11 essential keywords, including cryolipolysis, high-intensity focused ultrasound (HIFU), shock wave, low-level laser therapy (LLLT), radiofrequency (RF), capacitive resistive electrical transfer (TECAR), high-intensity focused electromagnetic (HIFEM), electromyostimulation (EMS), carboxytherapy, mesotherapy, and acupuncture and their abbreviations, in addition to obesity, overweight, cellulite, subcutaneous fat, and body contouring. RESULTS Totally 193 references were used in 11 main topics. CONCLUSION In order to help physicians with finding the best evidence in different methods, the data were summarised in 11 topics. Furthermore, FDA-approved devices, side effects and common protocols were described in each section. LEVEL OF EVIDENCE I This journal requires that authors 39 assign a level of evidence to each article. For a full 40 description of these Evidence-Based Medicine ratings, 41 please refer to the Table of Contents or the online 42 Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Zahra Alizadeh
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Farzin Halabchi
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Bodaghabadi
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Abolhasani
- Cardiovascular Diseases Research Centre, Cardiac primary prevention research center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Seifi
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reyhaneh Khazaei
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shima Ghanadi
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Mazaheri
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mastaneh Rajabian Tabesh
- Cardiac Primary Prevention Research Center (CPPRC), Heart Centre Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Sturm A, Shokri T, Ducic Y. Nonsurgical Rejuvenation of the Neck. Clin Plast Surg 2023; 50:497-507. [PMID: 37169415 DOI: 10.1016/j.cps.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Nonsurgical skin tightening in the neck is an area of significant growth with seemingly countless devices. Optimal treatment choice depends on the patient's concerns, anatomy, and lifestyle. Patients with minimal skin laxity, but dynamic platysmal bands may benefit from botulinum toxin injections. Mild to moderately lax skin can be addressed with microfocused ultrasound or radiofrequency with microneedling. Significant sun damage and laxity can both be addressed with fractional ablative lasers. Options for submental preplatysmal fat include percutaneous radiofrequency, radiofrequency-helium plasma, deoxycholic acid injections, and cryolipolysis. Of these, percutaneous radiofrequency has the highest patient satisfaction and lowest complication rate.
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Affiliation(s)
- Angela Sturm
- Private Practice, 6750 West Loop South, Suite 1060, Bellaire, TX 77401, USA; Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA.
| | - Tom Shokri
- George Washington University, 2300 M Street, NW, 4th Floor, Washington, DC 20037, USA
| | - Yadro Ducic
- Private Practice, 4300 North Central Expressway #110, Dallas, TX 75206, USA
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Sturm A, Shokri T, Ducic Y. Nonsurgical Rejuvenation of the Neck. Facial Plast Surg Clin North Am 2022; 30:407-417. [DOI: 10.1016/j.fsc.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Yin B, Zhang X, Cai L, Han X, Li F. Low Negative Pressure Combined With Supertumescence Microliposuction as a New Method for Repairing Facial Fat Overfilling: A Case Series of 32 Patients. Aesthet Surg J 2022; 42:NP193-NP200. [PMID: 34173820 DOI: 10.1093/asj/sjab260] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Face fat overfilling sometimes occurs and is unfortunately very difficult to repair. OBJECTIVES The aim of this study was to report initial experience of microliposuction with low negative pressure combined with supertumescence (LNPST) in a case series of 32 patients. METHODS The LNPST microliposuction was performed in 32 patients aged 22 to 41 years (mean [standard deviation] age, 29.6 [4.9] years) with facial overfilling. Discomfort and bleeding were monitored intraoperatively by 2 independent plastic surgeons, who used a grading system to record the results. All patients were followed-up for hematoma within 1 week postoperatively and for skin numbness and muscle paralysis at 1 week and 3 months postoperatively. In addition, at 6 months postoperatively, patient satisfaction with the postoperative aesthetic effects was analyzed by FACE-Q questionnaire. RESULTS All patients successfully completed the operation under local anesthesia. The mean intraoperative discomfort and blood-loss scores were 1.69 [0.62] and 1.22 [0.41], respectively. The hematoma score was 1.13 [0.34] within 1 week. Other scores included postoperative skin numbness (1 week, 1.96 [0.62]; 3 months, 1.13 [0.33]) and postoperative muscle paralysis (1 week, 1.22 [0.51]; 3 months, 1.0 [0]). Overall, neither skin necrosis nor serious complications requiring revision surgery occurred. Seventy-two percent of the patients (n = 23) answered the FACE-Q questionnaire and the score was 21.8 (1.7), covering satisfaction with the outcome score into a standard score (81.7 [15.1], from 0 to 100), which verified the high satisfaction rate. CONCLUSIONS LNPST technology is a safe and effective method for repair of facial fat overfilling, with less bleeding, less nerve injury, fewer complications, and high patient satisfaction. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Bo Yin
- Department of Body Contouring and Fat Grafting Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinyu Zhang
- Department of Body Contouring and Fat Grafting Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Cai
- Department of Body Contouring and Fat Grafting Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuefeng Han
- Department of Body Contouring and Fat Grafting Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Facheng Li
- Department of Body Contouring and Fat Grafting Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Farina GA, Koth VS, Maito FLDM, Payeras MR, Cherubini K, Salum FG. Adverse effects of deoxycholic acid in submandibular glands, submental, inguinal and subplantar regions: a study in rats. Clin Oral Investig 2022; 26:2575-2585. [PMID: 35088226 DOI: 10.1007/s00784-021-04227-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 10/12/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We aimed to evaluate the effects of the deoxycholic acid (DCA) in the submental and subplantar regions of rats, and to histologically analyze the changes caused in the submandibular glands, soft tissues of the paw, and inguinal adipose tissue. MATERIAL AND METHODS Sixty male Wistar rats were divided into DCA and control (CG) groups. DCA was injected in the submental, inguinal, and subplantar regions, and saline was injected in the CG. The animals were euthanized after 24 h and at 7 and 21 days. RESULTS The DCA group showed edema in the submental region in 24 h and in the paw in all experimental times. In the paw there were also erythema and ulceration in 7 days, and alopecia after 21 days. At 21 days, a few animals also showed erythema and ulceration in paw; however, there was no significant difference from CG. Histological analysis of the paw showed an intense inflammatory process, with a predominance of neutrophils, lymphocytes, and plasma cells in 24 h and 7 days. In the adipose tissue, we observed loss of architecture and inflammatory infiltrate, followed with a lower number of adipose cells, and at 21 days, fibroplasia. In the submandibular glands we observed inflammatory infiltration, loss of tissue architecture, and fibrosis. CONCLUSIONS DCA produces a significant inflammatory process in the structures. It can cause skin ulcerations and, in salivary glands, it causes loss of tissue architecture and fibrosis. CLINICAL RELEVANCE There has been growing increase in the use of DCA for aesthetic purposes by health care providers. Due to the presence of important anatomical structures in the submental region, constant vigilance is required to report new adverse effects.
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Affiliation(s)
- Gabriela Alacarini Farina
- Oral Medicine Division, Pontifical Catholic University of Rio Grande Do Sul-PUCRS, Porto Alegre, Brazil
| | - Valesca Sander Koth
- Oral Medicine Division, Pontifical Catholic University of Rio Grande Do Sul-PUCRS, Porto Alegre, Brazil
| | - Fábio Luiz Dal Moro Maito
- Oral Pathology Division, Pontifical Catholic University of Rio Grande Do Sul-PUCRS, Porto Alegre, Brazil
| | - Márcia Rodrigues Payeras
- Oral Pathology Division, Pontifical Catholic University of Rio Grande Do Sul-PUCRS, Porto Alegre, Brazil
| | - Karen Cherubini
- Oral Medicine Division, Pontifical Catholic University of Rio Grande Do Sul-PUCRS, Porto Alegre, Brazil
| | - Fernanda Gonçalves Salum
- Oral Medicine Division, Pontifical Catholic University of Rio Grande Do Sul-PUCRS, Porto Alegre, Brazil.
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Farina GA, Cherubini K, de Figueiredo MAZ, Salum FG. Deoxycholic acid in the submental fat reduction: A review of properties, adverse effects, and complications. J Cosmet Dermatol 2020; 19:2497-2504. [PMID: 32654409 DOI: 10.1111/jocd.13619] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Deoxycholic acid (DCA) was developed by the pharmaceutical industry for aesthetical use in submental fat reduction. It represents the first lipolytic substance approved by the Food and Drug Administration (FDA) for fat reduction in that area. AIMS This study presents an update of properties and the use of DCA, as well as adverse events and possible complications. METHODS A search in MEDLINE/PubMed, Cochrane, and Bireme/LILACS databases was performed using the terms: "deoxycholic acid" OR "ATX-101" AND "injection" NOT "amphotericin" NOT "biliary" NOT "bile." Experimental studies developed in animals, clinical trials, literature reviews, case reports, and letters to the editor that included the DCA mechanism of action, dose, manner of use, adverse effects, and complications were selected. RESULTS The most frequent adverse events are edema, local pain, bruise, and numbness, which usually spontaneously regress. However, complications, including, skin necrosis, nerve injury, alopecia, and vascular events, can occur, demanding complex management without specific protocols. CONCLUSION Although DCA is beneficial for lysis of adipose tissue, clinicians should be aware about the adverse effects and risks involved with the use of this substance. The knowledge of local anatomy, properties, and adverse effects are fundamental to treatment with DCA.
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Affiliation(s)
- Gabriela Alacarini Farina
- Oral Medicine Division, Pontifical Catholic University of Rio Grande do Sul-PUCRS, Porto Alegre, Brazil
| | - Karen Cherubini
- Oral Medicine Division, Pontifical Catholic University of Rio Grande do Sul-PUCRS, Porto Alegre, Brazil
| | | | - Fernanda Gonçalves Salum
- Oral Medicine Division, Pontifical Catholic University of Rio Grande do Sul-PUCRS, Porto Alegre, Brazil
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Evaluation of Safe and Effectiveness of an Injectable Solution Acid Deoxycholic Based for Reduction of Localized Adiposities. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1794. [PMID: 30276043 PMCID: PMC6157955 DOI: 10.1097/gox.0000000000001794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/03/2018] [Indexed: 11/25/2022]
Abstract
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.
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Anatomical and Clinical Implications of the Deep and Superficial Fat Compartments of the Neck. Plast Reconstr Surg 2017; 140:405e-414e. [DOI: 10.1097/prs.0000000000003618] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Souyoul S, Gioe O, Emerson A, Hooper DO. Alopecia after injection of ATX-101 for reduction of submental fat. JAAD Case Rep 2017; 3:250-252. [PMID: 28560296 PMCID: PMC5443891 DOI: 10.1016/j.jdcr.2017.02.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Skylar Souyoul
- Department of Dermatology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Olivia Gioe
- Louisiana State University School of Medicine, New Orleans, Louisiana
| | - Ashley Emerson
- Department of Dermatology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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Commentary on Overview of ATX-101 (Deoxycholic Acid Injection). Dermatol Surg 2016; 42 Suppl 1:S271-S274. [PMID: 27631458 DOI: 10.1097/dss.0000000000000813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rzany B, Griffiths T, Walker P, Lippert S, McDiarmid J, Havlickova B. Reduction of unwanted submental fat with ATX-101 (deoxycholic acid), an adipocytolytic injectable treatment: results from a phase III, randomized, placebo-controlled study. Br J Dermatol 2014; 170:445-53. [PMID: 24147933 PMCID: PMC4232897 DOI: 10.1111/bjd.12695] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2013] [Indexed: 12/01/2022]
Abstract
Summary What's already known about this topic? What does this study add?
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Affiliation(s)
- B Rzany
- Division of Evidence-Based Medicine in Dermatology, Charité-Universitätsmedizin, and RZANY & HUND, Privatpraxis und klinisches Studienzentrum für Dermatologie, Berlin, Germany
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Tonucci LB, Mourão DM, Ribeiro AQ, Bressan J. Noninvasive body contouring: biological and aesthetic effects of low-frequency, low-intensity ultrasound device. Aesthetic Plast Surg 2014; 38:959-67. [PMID: 25192747 DOI: 10.1007/s00266-014-0391-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/18/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent advancements in body-contouring techniques have prompted the investigation of ultrasound (US) technology as a potential noninvasive alternative for nonobese subjects for lifting, tightening, and reducing small areas of unwanted fat. This prospective study aimed to evaluate the biological and aesthetic effects of a low-frequency, low-intensity US device in reducing localized fat deposits for improving the body contours. METHODS A total of 20 female subjects included in this study were subjected to low-frequency US in the abdomen area. The effectiveness of this technique was determined by measuring changes in the anthropometric measurements and body composition, photographs, and a Client Satisfaction Questionnaire. The safety of the technique for application was determined by assessing the clinical features and biochemical tests results. RESULTS After five US sessions, a significant mean reduction of 1.5, 2.1, and 1.9 cm was noted in the waist, abdominal, and umbilical circumferences, respectively. No significant changes were noted in the levels of free fatty acids, insulin, liver enzymes, or lipid profile. However, a significant increase in the fasting glucose level was noted. However, four adverse side effects were reported: mild burning or discomfort, tingling or unilateral numbness in the lower limbs, pain around the bony areas, and soreness in the abdomen. CONCLUSION The low-frequency, low-intensity US device provides reduction in the abdominal region with a moderate level of satisfaction. However, more studies are required to assess the effectiveness of US for body contouring and its effect on glucose metabolism.
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Affiliation(s)
- Livia Bordalo Tonucci
- Department of Nutrition and Health, Federal University of Viçosa, Av. PH Rolfs, s/n, Campus UVF, CCB II, Viçosa, Minas Gerais, 36.570-000, Brazil,
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McDiarmid J, Ruiz JB, Lee D, Lippert S, Hartisch C, Havlickova B. Results from a pooled analysis of two European, randomized, placebo-controlled, phase 3 studies of ATX-101 for the pharmacologic reduction of excess submental fat. Aesthetic Plast Surg 2014; 38:849-60. [PMID: 24984785 PMCID: PMC4175004 DOI: 10.1007/s00266-014-0364-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 05/27/2014] [Indexed: 11/13/2022]
Abstract
BACKGROUND The injectable adipocytolytic drug ATX-101 is the first nonsurgical treatment for the reduction of submental fat (SMF) to undergo comprehensive clinical evaluation. This study aimed to confirm the efficacy and safety of ATX-101 for SMF reduction through a post hoc pooled analysis of two large phase 3 studies. METHODS Patients with unwanted SMF were randomized to receive 1 or 2 mg/cm(2) of ATX-101 or a placebo injected into their SMF during a maximum of four treatment sessions spaced approximately 28 days apart, with a 12-week follow-up period. The proportions of patients with reductions in SMF of one point or more on the Clinician-Reported SMF Rating Scale (CR-SMFRS) and the proportions of patients satisfied with the appearance of their face and chin [Subject Self-Rating Scale (SSRS) score ≥4] were reported overall and in subgroups. Other efficacy measures included improvements in the Patient-Reported SMF Rating Scale (PR-SMFRS), calliper measurements of SMF thickness, and assessment of skin laxity [Skin Laxity Rating Scale (SLRS)]. Adverse events and laboratory test results were recorded. RESULTS Significantly greater proportions of the patients had improvements in clinician-reported measures (≥1-point improvement in CR-SMFRS: 58.8 and 63.8 % of the patients who received ATX-101 1 and 2 mg/cm(2), respectively, and 28.6 % of the placebo recipients; p < 0.001 for both ATX-101 doses vs. placebo) and patient-reported measures (≥1-point improvement in PR-SMFRS: 60.0 and 63.1 % of the patients who received ATX-101 1 and 2 mg/cm(2), respectively, vs. 34.3 % of the placebo recipients; p < 0.001 for both), analyzed alone or in combination, with ATX-101 versus placebo. These improvements correlated moderately with patient satisfaction regarding face and chin appearance (SSRS score ≥4: 60.8 and 65.4 % of the patients who received ATX-101 1 and 2 mg/cm(2), respectively, vs. 29.0 % of the placebo recipients; p < 0.001 for both). In this study, ATX-101 was effective irrespective of gender, age, or body mass index. Reduction in SMF with ATX-101 was confirmed by calliper measurements (p < 0.001 for both doses vs. placebo) and generally did not lead to worsening of skin laxity (SLRS improved or was unchanged: 91.3 and 90.5 % of the patients who received ATX-101 1 and 2 mg/cm(2), respectively, and 91.6 % of the placebo recipients). Adverse events were mostly transient, mild to moderate in intensity, and localized to the treatment area. CONCLUSION The findings show ATX-101 to be an effective and well-tolerated pharmacologic treatment for SMF reduction.
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Affiliation(s)
| | | | - Daniel Lee
- KYTHERA Biopharmaceuticals, Inc., Calabasas, CA USA
| | - Susanne Lippert
- Global Clinical Development Dermatology, Bayer HealthCare, Sellerstrasse 31, 13353 Berlin, Germany
| | - Claudia Hartisch
- Global Clinical Development Dermatology, Bayer HealthCare, Sellerstrasse 31, 13353 Berlin, Germany
| | - Blanka Havlickova
- Global Clinical Development Dermatology, Bayer HealthCare, Sellerstrasse 31, 13353 Berlin, Germany
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Hübner NF, Horch RE, Polykandriotis E, Rau TT, Dragu A. A histopathologic and immunohistochemical study on liquification of human adipose tissue ex vivo. Aesthetic Plast Surg 2014; 38:976-84. [PMID: 25015550 DOI: 10.1007/s00266-014-0371-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 06/14/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND This preliminary ex vivo study aimed to clarify the pathophysiologic mechanisms of fat tissue depletion by subcutaneous drug application. Therefore, the lipolytic effects of phosphatidylcholine plus deoxycholate (Lipostabil) (L) and of deoxycholate (DC) alone were compared with those of sodium chloride (NaCl) and hydrogen peroxide (H2O2) as control agents. The study enrolled 10 patients receiving abdominoplasty. The treatment periods for each sample and solution were 1, 3, 5, and 7 h. The samples were analyzed morphologically using hematoxylin-eosin (H&E) staining and also immunohistochemically using Caspase 3 and tumor necrosis factor (TNF)-alpha. Morphologic changes were seen best after 5 h of application time. Except for NaCl, all the samples in the H&E staining showed marked damage of adipocyte cell membranes, with the greatest disruption of normal cell architecture after hydrogen peroxide (H2O2) application. Immunohistochemistry using TNF-alpha showed positive results for the deoxycholate and Lipostabil samples and highly positive results for the H2O2 sample. Data from this study indicate that Lipostabil and deoxycholate induce pathways of cell necrosis involving TNF-alpha. These short-term experiments indicate that Lipostabil affects fat tissue in the way of a chemical-toxic destruction rather than via a physiologically induced, programmed cell death.
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Affiliation(s)
- Nina-Fee Hübner
- Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
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Jones D. Erratum. Dermatol Surg 2013. [DOI: 10.1111/dsu.12384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Derek Jones
- Department of Dermatology; UCLA; Los Angeles California
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Won TJ, Nam Y, Lee HS, Chung S, Lee JH, Chung YH, Park ES, Hwang KW, Jeong JH. Injection of phosphatidylcholine and deoxycholic acid regulates gene expression of lipolysis-related factors, pro-inflammatory cytokines, and hormones on mouse fat tissue. Food Chem Toxicol 2013; 60:263-8. [PMID: 23911798 DOI: 10.1016/j.fct.2013.07.057] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/18/2013] [Accepted: 07/21/2013] [Indexed: 10/26/2022]
Abstract
Injection of phosphatidylcholine (PC) and deoxycholic acid (DA) preparation is widely used as an alternative to liposuction for the reduction of subcutaneous fat. Nevertheless, its physiological effects and mechanism of action are not yet fully understood. In this report, PC and deoxycholic acid (DA) were respectively injected into adipose tissue. PC decreased tissue mass on day 7, but DA did not. On the other hand, a decrement of DNA mass was observed only in DA-injected tissue on day 7. Both PC and DA reduced the mRNA expression of adipose tissue hormones, such as adiponectin, leptin, and resistin. In lipolysis-related gene expression profiles, PC increased hormone-sensitive lipase (HSL) transcription and decreased the expression other lipases, perilipin, and the lipogenic marker peroxisome proliferator-activated receptor-γ (PPARγ); DA treatment diminished them all, including HSL. Meanwhile, the gene expression of pro-inflammatory cytokines and a chemokine was greatly elevated in both PC-injected and DA-injected adipose tissue. Microscopic observation showed that PC induced lipolysis with mild PMN infiltration on day 7. However, DA treatment did not induce lipolysis but induced much amount of PMN infiltration. In conclusion, PC alone might induce lipolysis in adipose tissue, whereas DC alone might induce tissue damage.
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Affiliation(s)
- Tae Joon Won
- Laboratory of Host Defense Modulation, College of Pharmacy, Chung-Ang University, Seoul 156-756, Republic of Korea
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Kim IS, Hyun MY, Park KY, Kim CW, Kim BJ, Kim MN. Phosphatidylcholine and bipolar radiofrequency for treatment of localized fat deposits. J DERMATOL TREAT 2013; 25:308-9. [PMID: 23621400 DOI: 10.3109/09546634.2013.783198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Bipolar radiofrequency (RF) is capable of delivering higher energy fluencies direct to the dermis through a needle electrode. This produces heat when the tissue electrical resistance converts the electric current to thermal energy in the tissue. A 38-year-old man visited our clinic for reduction of submental fat deposit, but otherwise in overall good health. After deciding to perform phosphatidylcholine (PPC) injections subcutaneously, we concerned about edema and swelling of injection site lasted several weeks. We wanted to shorten the period of edema and swelling, and we decided to add bipolar RF treatment. After 1 week of PPC injection combined with RF treatment, overall volume of jowl was decreased and edema and swelling on the PPC injected site markedly subsided. This reduction of fat deposit lasts longer than 1 year. Follow-up for 1 year demonstrated that the cosmetic results were well maintained.
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Affiliation(s)
- In Su Kim
- Department of Dermatology, Chung-Ang University College of Medicine , Seoul , South Korea
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20
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Reeds DN, Mohammed BS, Klein S, Boswell CB, Young VL. Metabolic and structural effects of phosphatidylcholine and deoxycholate injections on subcutaneous fat: a randomized, controlled trial. Aesthet Surg J 2013; 33:400-8. [PMID: 23439063 PMCID: PMC3667691 DOI: 10.1177/1090820x13478630] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2012] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Phosphatidylcholine and deoxycholate (PC-DC) injections are a popular nonsurgical method to eliminate unwanted fat. The safety and efficacy of this approach is uncertain. OBJECTIVE The authors evaluate the effects of PC-DC treatments on body composition, adipocyte function, and mechanisms responsible for fat loss. METHODS This randomized, open-label study enrolled 13 women with a body mass index (BMI) ≤30 kg/m(2) and lower abdominal subcutaneous fat suitable for small-volume liposuction. Patients were randomized by the final digit of their Social Security numbers and received between 2 and 4 PC-DC treatments, spaced 8 weeks apart. One side below the umbilicus was injected with PC-DC. The contralateral, control side received no treatment. Adipose tissue biopsies were performed on the treated side at baseline, 1 week after the first treatment, and 8 weeks after the final treatment. The primary outcome was change in adipose tissue thickness at baseline and 8 weeks after the final treatment. RESULTS Seven women completed the study. Treatment with PC-DC significantly reduced the thickness of the anterior subcutaneous abdominal fat (P = .004). Adipose tissue showed rapid increases in crown-like structures, macrophage infiltration, and reduced expression of leptin, hormone-sensitive lipase, adipose tissue triglyceride lipase, and CD36. Plasma C-reactive protein, lipid profile, and plasma glucose concentrations were unchanged. CONCLUSIONS PC-DC injections can effectively reduce abdominal fat volume and thickness by inducing adipocyte necrosis. These treatments do not appear to increase circulating markers of inflammation or affect glucose and lipid metabolism.
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Affiliation(s)
- Dominic N Reeds
- Washington University School of Medicine, St Louis, Missouri, USA
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21
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Abstract
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.
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Affiliation(s)
- K Hoffmann
- Klinik für Dermatologie und Allergologie der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum.
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22
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Grether-Beck S, Krutmann J. [Adipose tissue. Cellular and molecular principles]. Hautarzt 2010; 61:838-46. [PMID: 20871971 DOI: 10.1007/s00105-010-1983-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
For many decades, cutaneous biology research has primarily focused on the dermis and epidermis. In recent years the subcutaneous far has attracted the attention of basic science, cosmetology and industry. Numerous new approaches are in the process of development, enabling us to better understand assembly, differentiation and function of adipose tissue. To understand these developments a background in the cellular and molecular basics of adipose tissue is indispensable. This state-of the art article provides the needed information.
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Affiliation(s)
- S Grether-Beck
- Institut für umweltmedizinische Forschung, Auf'm Hennekamp 50, 40225, Düsseldorf
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23
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Rotunda AM, Jones DH. Human immunodeficiency virus-associated lipohypertrophy (buccal fat pad lipoma-like lesions) reduced with subcutaneously injected sodium deoxycholate. Dermatol Surg 2010; 36:1348-54. [PMID: 20584039 DOI: 10.1111/j.1524-4725.2010.01638.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Adam M Rotunda
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 92660, USA.
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24
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Rotunda AM. Injectable treatments for adipose tissue: Terminology, mechanism, and tissue interaction. Lasers Surg Med 2009; 41:714-20. [PMID: 20014257 DOI: 10.1002/lsm.20807] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Adam M Rotunda
- Division of Dermatology, David Geffen School of Medicine, University of California, Los Angeles, CA 92660, USA.
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25
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Coleman KM, Coleman WP, Benchetrit A. Non-Invasive, External Ultrasonic Lipolysis. ACTA ACUST UNITED AC 2009; 28:263-7. [PMID: 20123426 DOI: 10.1016/j.sder.2009.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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