Lipodissolve & Mesotherapy: the low-down

Here's a hot topic: can you melt fat by injecting certain active substances into it, and is this safe to do? Those are the key questions to be determined when in comes to injection lipolysis, also known as Lipodissolve, Flab-jab, and a number of other proprietary names.

Currently, the two most commonly used drugs, the soybean-derived phosphatidylcholine (PC) and a bile-salt derivative called deoxycholate (DC), are not FDA-approved for this purpose. These are injected, sometimes with a cocktail of other ingredients, into the fat, using a grid-like pattern. This is typically repeated at intervals, until the desired results are seen, or the patient gives up, or runs out of money!

While this procedure is poorly-understood and needs a whole lot more research to determine the best way to do it, here's what we do know from the scientific studies:

1) The injections don't "melt" fat - they cause the fat cells to rupture, killing the fat, which is then replaced by scar tissue;
2) The DC seems to be more effective in causing the effect, compared to the PC;
3) Some studies have found no benefit whatsoever; others have seen a measurable effect, with a reduction in fat;
4) We don't really know the optimal dosage and mix of ingredients;
5) We don't know where the "melted" fat goes, and whether this process has side effects;
5) Some people have reactions to the injections, with pain, swelling and lumpiness. Fortunately, most of these reactions are usually transient;
6) Some people have no response to the treatment, other than the inevitable thinning of their wallet. These people usually come to me later, for actual liposuction.

So far, I feel that injection lipolysis should be classified as an experimental procedure. Although I'm very interested in it, I don't offer it to my patients. I feel that the details really need to be worked out first. Liposuction is still the undisputed standard for fat removal.

Regulatory approval would also help me feel better about this technique. When the FDA, Health Canada, the UK's Medicines and Healthcare Products Regulatory Agency (MHRA), and the Brazilian version of the FDA all speak out against this procedure, that should tell you something. It's probably not "ready for prime time" yet.

The research wing of ASAPS (American Society for Aesthetic Plastic Surgery) has a study going on this right now. I'll post the results as soon as they are available. Personally, I'd like for this technique to work - it would add another useful method to those we use currently, and would be minimally-invasive, as well. We'll have to wait and see...