Las Vegas - Lipodissolve, a treatment some doctors believe tobe a form of mesotherapy, is evolving to be highly effective fortreatment of post-liposuction irregularities and cellulite, but thetherapy is not a replacement for liposuction and proper training isessential, according to Barry Lycka, M.D., speaking at the annualmeeting of the American Society of Cosmetic Dermatology andAesthetic Surgery here.
Lipodissolve specifically involves the injection of phosphatidycholine (250 mg/ml) and sodium deoxycholate (4.7 percent) into the subcutaneous fat, with the sodium deoxycholate being the active ingredient.
By itself, the phosphatidycholine, made of soy products, has no effect on the fat. The sodium deoxycholate, found in bile salts, is the active ingredient that is clinically effective at concentrations of at least 1 percent in breaking down fat cells.
Optimal with ultrasound
In the 300 or so patients Dr. Lycka says he has treated with lipodissolve, the procedure has been very well tolerated, and he says results are most optimal when combined with endermologie and ultrasound.
"I'll do the treatment and then two weeks later will do an endermologie treatment," says Dr. Lycka, an assistant clinical professor at the University of Alberta, Edmonton, Canada.
"I've just started adding ultrasound after the procedure, as they're doing in Europe," he adds. "And the results are even further enhanced."
Data review very positive
Dr. Lycka describes a review of data on 470 patients treated in 1,061 therapy sessions, conducted by the European Lipodissolve Network, a group of 394 physicians. The study found that primary side effects were bruising and sensitivity to touch and patient satisfaction levels were high, with 74.9 percent reporting to be "very satisfied," 18.1 percent "satisfied" and 7 percent "less satisfied." (Lipolysis Report, European Lipodissolve Network, 2004.)
In another study of 3,500 lipodissolve injections on 1,500 patients between 2003 and 2005, researchers found an average abdominal response of 4 cm. Fourteen percent of patients reported satisfaction after a single injection, and 87 percent were satisfied after three injections (Aesthetic Surgery Journal;25:5;530-543).
And in a recent small study looking at the effect of only deoxycholate injections on lipomas among six patients, researchers saw an average of a 75 percent reduction of the lipoma, with patients receiving an average of 2.2 treatments.
The study found no relationship between lipoma dissolution and the deoxycholate concentration used, however they warned that an increase in deoxycholate concentration may not offer additional benefit, but may indeed contribute to adverse effects, such as pain and burning (J Am Acad Dermatol 2005;53:973-978).
"High concentrations of deoxycholate should not be used without phosphatidycholine because of side effects," Dr. Lycka warns.
Skilled technique important
One of the most important caveats with lipodissolve is perfecting the technique. This is a specific injection done a specific way, and learning the technique is as important as learning technique when injecting Botox, Dr. Lycka says. "So it's important to get some training."
Injections should be made at the right depth of no more than 1 cm apart, and the phosphatidycholine/ sodium deoxycholate concentration is best tolerated with 1 percent deocycholate and 1 percent deocycholate/ procaine.
"I find that procaine takes away burning and adds to the efficacy of the result," Dr. Lycka explains.