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Lipodissolve: Under Scrutiny

By Denise Mann; reviewed by Peter Fodor, MD, FACS

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Perhaps you have heard of lipodissolve. There is much buzz about this experimental "fat-melting" technology, which is being billed as a non-surgical alternative to liposuction. While studies are now looking at just how effective lipodissolve really is, nothing tops liposuction when it comes to the removal of unwanted fat.

Liposuction is the only scientifically proven method for removing fat cells permanently and is the top overall surgical cosmetic procedure performed in the United States.

Here's what we know now about lipodissolve and what we still need to learn.

Lipodissolve: The Promise

Lipodissolve involves a series of medicated injections that may melt away unwanted small, localized areas of fat. Think love handles, saddlebags and muffin tops. Lipodissolve is also known as mesotherapy, lipolysis, injection lipolysis or lipostabil.

While the ingredients used in lipodissolve may vary depending on the doctor and the area being treated, the chemical cocktail typically includes phosphatidylcholine/deoxycholate (PCDC), multivitamins, alpha lipid acid, enzymes and plant extracts. Phosphatidylcholine is a soybean extract, and deoxycholate is a bile derivative. Phosphatidylcholine is FDA-approved to break down blood fats that may increase risk for heart disease, but it is not approved for injection or any other purpose.

Some doctors may also add non-steroidal anti-inflammatory medications, antibiotics and hormones to the mix. These chemical cocktails typically are prepared in compounding pharmacies, which specialize in customizing formulations of drugs based on a doctor's orders.

The bottom line? There is no standard ingredient list. Many of the individual ingredients are not FDA-approved on their own, not to mention as part of a chemical cocktail.

Lipodissolve proponents say this technology can reduce fat pockets in the upper and lower abdomen, thighs and upper arms, as well as get rid of love handles, saddlebags, muffin tops, bra rolls, residual fat deposits from liposuction, fat pads under the eyes or chin, cellulite, stretch marks and scars. Some say this technology can improve skin tone and elasticity, as well as increase the production of collagen, a protein that keeps the skin firm.

During lipodissolve, your doctor injects the chemical cocktail into the fat layers and connective tissue. The injection is relatively painless, with no need for anesthesia. The medication produces a chemical reaction in conjunction with the body's physiology to dissolve localized areas of fat. Typically, benefits are seen within three weeks of the treatment. Several treatments, four to six weeks apart, are often required to produce the optimal result. There is no down-time after lipodissolve.

Between 50,000 and 100,000 lipodissolve treatments have been performed in the United States and Europe, according to statistics from the American Society of Nonsurgical Aesthetics, a trade group.

Lipodissolve: The Problems

Lipodissolve injections do liquefy fat, but where the fat goes is anyone's guess. Potentially it could be filtered through the liver, creating a fatty liver. Such excess fat in the liver can result in inflammation and possible scarring and liver failure.

The liquefied fat may also wind up in the blood vessels, where it could add to existing fatty plaque and increase the risk of heart attack or stroke.

Also, no studies have demonstrated where the medication travels or how it may affect organs. Nor does research exist on the optimal ingredients, proper dosages or short-term side effects. The American Society for Aesthetic Plastic Surgery (ASAPS) reports that infection, disfiguring masses of inflamed tissue and tissue death can occur after lipodissolve, especially when the procedure is performed by laypeople. Buyer beware: Some plastic surgeons are seeing indentations and divets (depressions) in the skin of people who have undergone lipodissolve. Such defects can be extremely difficult to correct.

Lipodissolve should not be used in pregnant women, nursing mothers or obese individuals; or in people with diabetes, autoimmune diseases, vascular (blood vessel) complications or infections of any kind. It is not an appropriate treatment for large areas of fat.

Lipodissolve: Current Status

Lipodissolve is experimental. It is not approved by the FDA. Clinical studies in the United States that look at the safety and efficacy of lipodissolve are underway. Some medical practices that offer lipodissolve are also working toward establishing the right protocols for the procedure. Stay tuned.

At this time, neither ASAPS nor the American Society of Plastic Surgeons recommends the use of this technology. What's more, at least two states, Kansas and Nebraska, are in the process of enacting legislation to ban lipodissolve. Specifically, mesotherapy is temporarily banned in Kansas unless it is done as part of an FDA-approved clinical trial. Legislation in Nebraska is seeking to ban this procedure until it receives FDA approval. The state of Nevada is also considering such a ban.

And that is just in the United States. ANVISA, the Brazilian FDA, banned the use of phosphatidylcholine-based products for injectable fat removal because they have never been approved for cosmetic use. And Health Canada, the Canadian FDA, has ordered physicians to stop marketing and administering the products.

Lipodissolve: Study Update

ASAPS recently started a study of mesotherapy. The study protocol includes standardized ingredients and aims to look at safety and efficacy in a controlled and scientific fashion. In this study, 20 people will have half of their lower abdomen injected with phosphatidylcholine/deoxycholate (PCDC) up to four times, with a minimum of two times. The treatments will be spaced out eight weeks apart.

Study participants will have the option to get the other side of their abdomen treated if they are pleased with the results at the study's end. As of mid-June 2008, 10 people were enrolled.

Protect Yourself: What to Ask Your Surgeon Before You Choose Lipodissolve

Plastic surgeons and dermatologists may have experience with lipodissolve by participating in clinical trials. There may also be other types of doctors who are investigating the use of lipodissolve through study participation. Before you consider lipodissolve:

  • Review the doctor's credentials, education, training, type of certification held and the number of times that he has performed the treatment.
  • View before-and-after photos of patients with similar conditions who received lipodissolve and alternative treatments such as liposuction. As mentioned above, liposuction, a surgical procedure, is the only method that is scientifically proven to remove fat cells permanently.
  • Ask about the ingredients in the medication and the amount of medication to be used in your procedure.
  • Ask the doctor to estimate the number of treatments required to achieve and maintain the benefit.
  • Ask about any possible interactions with your medical conditions or with medications you are already taking or plan to take.

Lipodissolve Costs

Costs for lipodissolve may range from $375 to $1,500 per treatment. Up to six treatments may be needed.

The extent of treatment also makes a cost difference. For example, fat removal under the eyes or chin will cost less than removal of saddlebags. The amount of medication required also depends on the area to be treated.

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[page updated June 2009]