Injection lipolysis

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Injection lipolysis is a controversial cosmetic procedure in which drug mixtures are injected into patients with the goal of destroying fat cells. This practice, using drugs generally based on phosphatidylcholine and deoxycholate (PCDC), evolved from the initial intravenous use of those drug formulations to treat blood disorders. [1] [2]

Contents

While no placebo-controlled studies have demonstrated the safety or efficacy of this therapy, numerous retrospective studies of Lipostabil injections have reported the efficacy of this practice. [2] [3] [4] [5] [6] [7] [8] [9] [10] The mixture is injected directly into the subcutaneous fat through multiple microinjections administered over multiple treatment sessions. The desired end result is the removal of localized fat deposits. [2]

History

In 1966, investigators noted that the intravenous infusion of PC-containing solutions could remove fat emboli. [11] Later, a drug formulation called Lipostabil containing 5% PC and 2.5% deoxycholate (DC) was approved in Germany and used in the treatment of fat embolism, [12] [13] dyslipidemia, [14] and alcohol-induced liver cirrhosis. [15] The first report of Lipostabil injection for fat removal demonstrated that infra-orbital ("under the eyelid") fat could be removed by Lipostabil injection. [16]

Health warnings

Three medical associations have issued health warnings cautioning against the use of injection lypolysis, including the American Society of Plastic Surgeons (ASPS), the American Society for Aesthetic Plastic Surgery (ASAPS), and the American Society of Dermatologic Surgery (ASDS).The Aesthetic Surgery Education and Research Foundation has funded on behalf of the American Society for Aesthetic Plastic Surgery a half side comparison study with interesting results [17]

Restrictive action taken by FDA against Lipodissolve

On April 7, 2010, the US Food and Drug Administration issued Warning Letters to six U.S. based medical spas and a company in Brazil for making false or misleading statements on their Web sites about drugs they claim will eliminate fat in a procedure called "lipodissolve", or for otherwise misbranding lipodissolve products. "We are concerned that these companies are misleading consumers", said Janet Woodcock, M.D., director of the FDA's Center for Drug Evaluation and Research. "It is important for anyone who is considering this voluntary procedure to understand that the products used to perform lipodissolve procedures are not approved by the FDA for fat removal".

For the complete FDA statement, see here .

To see the warning letter, see .

The FDA has received reports of adverse effects in persons who have had the procedure using these drugs, including permanent scarring, skin deformation, and deep painful knots under the skin in areas where the lipodissolve products have been injected. The warning letters were issued to the following U.S. companies: Monarch Medspa, King of Prussia, Pa; Spa 35, Boise, Idaho; Medical Cosmetic Enhancements, Chevy Chase, Md.; Innovative Directions in Health, Edina, Minn PURE Med Spa, Boca Raton, Fl.; and All About You Med Spa, Madison, Ind. The Brazilian company receiving a warning letter markets lipodissolve products on two Web sites: zipmed.net and mesoone.com.

The FDA is requesting a written response from the U.S. companies within 15 business days of receipt of the warning letters stating how they will correct these violations and prevent similar violations in the future. Each U.S. company has been informed in its warning letter that failure to promptly correct the violations may result in legal action. Each of the companies involved has been cited for a variety of regulatory violations, including making unsupported claims that the products have an outstanding safety record and are superior to other fat loss procedures, including liposuction. Additionally some of the letters indicate that the companies have made claim that lipodissolve products can be used to treat certain medical conditions, such as male breast enlargement, benign fatty growths known as lipomas, excess fat deposits and surgical deformities. The FDA is not aware of clinical evidence to support any of these claims.[ citation needed ]

International regulation

The Medicines and Healthcare products Regulatory Agency, the governmental body regulating the manufacture and commercialization of drugs in the United Kingdom, issued a similar warning to physicians considering the use of these substances for cosmetic purposes, stating these drugs "are being unlawfully advertised in the UK as a cosmetic product for the reduction of fat." The MHRA also pointed out that considerable safety concerns remain because these agents have not been tested in controlled clinical trials. While British physicians can still inject Lipodissolve for fat removal, the drug cannot be promoted as a drug for that purpose. As of July, 2005, The Medical Protection Society, the organization that provides British doctors with legal advice and coverage against litigation costs and damages, ceased offering malpractice insurance for use of Lipodissolve because of safety concerns. [18]
On the other hand the therapy is very often administered especially in German speaking countries because the drug Lipostabil N has been approved in Germany for more than 40 years. A physicians' network, the NETWORK-Lipolysis with 3,000 members worldwide amongst them 1,000 alone in German speaking countries has collected safety data. The latest published so-called Lipolysis Report 2015 has been published in 2016. [19] 4% of the members have answered the survey. 29,889 patient results have been collected with in total ca. 76,000 treatment sessions. Nowadays the composition is compounded by pharmacies in Germany and Switzerland.[ citation needed ]

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Lipolysis Metabolism involving breakdown of lipids

Lipolysis is the metabolic pathway through which lipid triglycerides are hydrolyzed into a glycerol and three fatty acids. It is used to mobilize stored energy during fasting or exercise, and usually occurs in fat adipocytes. The most important regulatory hormone in lipolysis is insulin; lipolysis can only occur when insulin action falls to low levels, as occurs during fasting. Other hormones that affect lipolysis include glucagon, epinephrine, norepinephrine, growth hormone, atrial natriuretic peptide, brain natriuretic peptide, and cortisol.

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Phosphatidylcholine Class of phospholipids

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Cellulite Medical condition

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Tesamorelin

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Fat removal procedures are used mostly in cosmetic surgery with the intention of removing unwanted adipose tissue. The procedure may be invasive, as with liposuction, or noninvasive using laser therapy, radiofrequency, ultrasound or cold (cryoablation) to reduce fat, sometimes in combination with injections.

References

  1. ↑ Matarasso, A.; Pfeifer, T.M. (2005). "Mesotherapy for body contouring". Plast Reconstr Surg. 115 (Pt 5): 1420–4. doi:10.1097/01.PRS.0000162227.94032.ED. PMID   15809611. S2CID   38159936.
  2. 1 2 3 Duncan, D.I.; Hasengschwandtner, F (2005). "Lipodissolve for Subcutaneous Fat Reduction and Skin Retraction". Aesthetic Surg J. 25 (Pt 5): 530–543. doi: 10.1016/j.asj.2005.07.009 . PMID   19338857.
  3. ↑ Rotunda, A.M., M.M. Avram, and Avram, A.S. (2005). "Cellulite: Is there a role for injectables?". Journal of Cosmetic and Laser Therapy. 7 (3–4): 147–54. doi:10.1080/14764170500430234. PMID   16414902. S2CID   40625377.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  4. ↑ Ablon G, Rotunda, AM. (2004). "Treatment of lower eyelid fat pads using phosphatidylcholine: clinical trial and review". Dermatologic Surgery. 30 (3): 422–7. doi:10.1097/00042728-200403000-00020. PMID   15008874.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  5. ↑ Hexsel, D., Serra, M., Mazzuco, R. (2003). "Phosphatidylcholine in the treatment of localized fat". Journal of Drugs in Dermatology. 2 (5): 511–8. PMID   14558399.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  6. ↑ Rotunda, A.M., G. Ablon, and M.S. Kolodney (2005). "Lipomas treated with subcutaneous deoxycholate injections". Journal of the American Academy of Dermatology. 53 (6): 973–8. doi:10.1016/j.jaad.2005.07.068. PMID   16310057.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  7. ↑ Rotunda, A.M.; M.S. Kolodney (2006). "Mesotherapy and Phosphatidylcholine Injections: Historical Clarification and Review". Dermatologic Surgery. 32 (4): 465–480. CiteSeerX   10.1.1.506.2372 . doi:10.1111/j.1524-4725.2006.32100.x. PMID   16681654. S2CID   9994696.
  8. ↑ Bechara, F.G., Sand, M., Hoffmann, K., Sand, D., Altmeyer, P., and Stucker, M. (2007). "Fat tissue after lipolysis of lipomas: a histopathological and immunohistochemical study". Journal of Cutaneous Pathology. 34 (7): 552–7. doi:10.1111/j.1600-0560.2006.00651.x. PMID   17576334. S2CID   39429064.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  9. ↑ Bechara, F.G., Sand, M., Altmeyer, P., and Hoffmann, K. (2006). "Intralesional lipolysis with phosphatidylcholine for the treatment of lipomas: pilot study". Arch Dermatol. 142 (8): 1069–70. doi:10.1001/archderm.142.8.1069-b. PMID   16924064.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  10. ↑ Bechara, F.G., Sand, M., Sand, D., Rotterdam, S., Stucker, M., Altmeyer, P., and Hoffmann, K. (2006). "Lipolysis of lipomas in patients with familial multiple lipomatosis: an ultrasonography-controlled trial". Journal of Cutaneous Medicine and Surgery . 10 (4): 155–9. doi:10.2310/7750.2006.00040. PMID   17234112. S2CID   45970041.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  11. ↑ Kroupa, J. (1966). "Lipostabil in the prevention of fat embolism. (Experimental study)". Rozhl Chir. 45 (Pt 7): 444–452. PMID   5924189.
  12. ↑ Schroder, D., Buttenschon, K., Herrmann, F., Brede, S. (1991). "Is there a drug treatment approach for prevention and therapy of fat embolism syndrome?". Klin Wochenschr. 69 (Pt 26): 229–233.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  13. ↑ Stohlmacher, P., Haferland, W., and Gottschall, S. (1975). "Diffuse foam cell pneumonia following fatty embolism treated with lipostabil. A contribution to the pathology of therapy". Z Arztl Fortbild (Jena). 69 (5): 237–239. PMID   1226856.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  14. ↑ Klimov, A.N., Konstantinov, V.O., Lipovetsky, B.M., Kuznetsov, A.S., Lozovsky, V.T., Trufanov, V.F., Plavinsky, S.L., Gundermann, K.J., and Schumacher. R.. (1995). ""Essential" phospholipids versus nicotinic acid in the treatment of patients with type IIb hyperlipoproteinemia and ischemic heart disease". Cardiovascular Drugs and Therapy. 9 (6): 779–784. doi:10.1007/bf00879871. PMID   8850382. S2CID   21578474.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  15. ↑ Lieber, C.S., Weiss, D.G., Groszmann, R., Paronetto, F., Schenker, S. (2003). "For the Veterans Affairs Cooperative Study 391 Group., II. Veterans Affairs Cooperative Study of polyenylphosphatidylcholine in alcoholic liver disease". Alcohol Clin Exp Res. 27 (11): 1765–1772. doi:10.1097/01.alc.0000093743.03049.80. PMID   14634492.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  16. ↑ Rittes, P.G. (2001). "The use of phosphatidylcholine for correction of lower lid bulging due to prominent fat pads". Dermatologic Surgery. 27 (4): 391–2. doi:10.1097/00042728-200104000-00014. PMID   11298713.
  17. ↑ Dominic N. Reeds, B. Selma Mohammed, Samuel Klein, Craig Brian Boswell and V. Leroy Young (2013), "Metabolic and Structural Effects of Phosphatidylcholine and Deoxycholate Injections on Subcutaneous Fat: A Randomized, Controlled Trial", Aesthetic Surgery Journal., vol. 33, no. 3, pp. 400–408, doi:10.1177/1090820X13478630, PMC   3667691 , PMID   23439063 {{citation}}: CS1 maint: multiple names: authors list (link)
  18. ↑ Lister, Sam (July 18, 2005). "Youre on your own if you give flab jab insurers warn doctors". The Times. London. Retrieved May 5, 2010.
  19. ↑ Weidmann M, Lettko M, Prantl L (2016), "Injektionslipolyse", J Ästhet Chir. (in German), vol. 9, no. 4, pp. 158–167, doi:10.1007/s12631-016-0047-2 {{citation}}: CS1 maint: multiple names: authors list (link)
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