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National report - To proponents of injection lipolysis, the procedure represents a safe, effective tool for dissolving fat without liposuction, significant pain or downtime. However, many dermatologists question these claims, citing growing numbers of complications and patient complaints.
Nevertheless, even some detractors say they'd welcome injection lipolysis should it ultimately prove safe and effective.
Old treatment, new concerns
The procedure has proven controversial in some foreign countries - Brazilian regulators have banned cosmetic products containing phosphatidylcholine, Health Canada has outlawed phosphatidylcholine injections for any indication, and UK regulators discourage cosmetic use of Lipostabil (phosphatidylcholine-deoxycholate/PCDC, Sanofi-aventis).
In the United States, mesotherapy has come to designate injections aimed at reducing fat and cellulite, he says. Data from the American Society for Aesthetic Plastic Surgery (ASAPS) show that from 2005 to 2006, the number of mesotherapy procedures performed by members grew from 4,773 to 28,901.
"People are looking for procedures that will give them positive results with very little downtime and no purported side effects," Dr. Zloty tells Dermatology Times.
Regarding physicians, about 3,000 United States doctors - 30 percent of whom are dermatologists and plastic surgeons - perform injection lipolysis, says Roman Chubaty, M.D., medical director of http://AestheticMD.com/, which offers lipotherapy training for physicians.
"Very few dermatologists are offering this procedure, due to its unapproved nature and the fact that most malpractice carriers would consider it an uncovered medical treatment, as it isn't FDA-approved and consists of a cocktail of unapproved drugs being injected, with little or no scientific study or analysis," says Joel Schlessinger, M.D., of Omaha, Neb., immediate past president, American Society of Cosmetic Dermatology and Aesthetic Surgery.
However, he says none of these claims have been substantiated in peer-reviewed journals.
"Until there is data to support safety and efficacy, we do not recommend the procedure," says Foad Nahai, M.D., ASAPS president.
Currently, he says, "There's enough for all of us to realize that this combination of drugs will, in fact, break up fat cells. But what happens to the fat? We don't know" if the procedure elevates patients' triglyceride levels.
The lack of a standardized lipotherapy protocol also causes concern, sources say.
"Currently, there are all kinds of drugs being used to try to dissolve localized fat deposits," Dr. Zloty says.
These include vitamins, hormones, alpha and beta blockers and even botulinum toxin, although the most popular ingredients are deoxycholate (DC) and phosphatidylcholine (PC), a combination initially marketed as Lipostabil (Sanofi-aventis), he says.