Lipolysis: a review of modern methods

Evgenia Lifshits, dermatologist, cosmetologist

To successfully correct the figure and local fat deposits, an integrated approach should be used based on the following principles:

• basic lipolytic methods reduce the volume and number of fat cells, promote the breakdown of fats;
• drainage procedures remove decay products and toxins formed during lipolysis from tissues;
• auxiliary techniques improve blood circulation in fatty and muscle tissues, preparing the body for the main procedures, potentiate and prolong their effect;
• supporting methods allow you to maintain the achieved results for a long time.

In cosmetology, the most widely used methods of non-surgical liposuction ( lipolysis ) are injection lipolysis, electrolipolysis, cavitation adipocytolysis, radio wave lipolysis, cryolipolysis, and laser liposuction.

Injection lipolysis and lipolytic mesotherapy

We will not leave this method outside the scope of the review, although it does not apply to hardware. Today, mesotherapy is one of the most effective ways to correct local fat deposits (LAD). This method can be successfully combined with hardware techniques, manual manipulation and various cosmetic care procedures. Among the drugs used for mesolipolysis, lipolytics of direct and indirect action should be distinguished. Indirect-acting lipolytics include substances such as organic silicon, caffeine, L-carnitine, artichoke, etc. The listed agents can accelerate metabolic processes in adipose tissue and have a pronounced drainage effect. Direct lipolytics are aimed at destroying the adipocyte itself (lipolysis).

According to the modern classification, the injection lipolysis procedure is considered as a separate technique, since the mechanism of action differs from the procedures of classical mesotherapy (“little, rarely, in the right place”). Most often, cocktails for injection lipolysis are a mixture of phosphotidylcholine and sodium deoxycholate, which have a combined effect on adipose tissue adipocytes. Deoxycholate is produced synthetically, and in the human body it is synthesized by the liver and is part of bile. By changing surface tension, deoxycholate disorganizes the cell membrane and promotes its destruction with the release of fatty acids into the intercellular space. Phosphatidylcholine is widespread in nature and is part of cell membranes. In the pharmaceutical industry, it is extracted from soybeans. Phosphatidylcholine is capable of emulsifying fats.

When performing injection lipolysis, the cocktail is injected strictly into the subcutaneous fatty tissue, avoiding the drug getting into the epidermis and dermis. Otherwise, tissue necrosis is possible. During the first day, an inflammatory reaction develops at the injection site with its characteristic clinical signs: hyperemia, pain and swelling. Local inflammation is the predicted course of the post-injection process and, in part, a criterion for the effectiveness of the procedure.

A course of therapy using this method consists of 2-6 procedures, which are carried out at intervals of 10-20 days.

Absolute contraindications for injection lipolysis include: childhood, pregnancy, lactation, soy intolerance, calculous cholecystitis, uncompensated insulin-dependent diabetes mellitus. Injection lipolysis is often considered as a therapeutic alternative to low volume liposuction.

Electrolipolysis

Electrolipolysis is the effect of alternating current of medium strength with a rectangular form of electromagnetic oscillations with a frequency of 20-50 Hz. This technique is one of the first attempts to correct LVH using physical methods and was patented in France at the end of the 19th century.

The operating principle of the electrolipolysis device is as follows: fat cells have a positive charge on the outer surface of the membrane, and a negative charge on the inner surface. During the session, the charge changes at a frequency of twenty times per minute. To change polarity, the cell must work hard and, accordingly, spend energy, the source of which is lipids. Thus, fats are emulsified, and breakdown products are excreted through the kidneys.

There are needle and electrode electrolipolysis procedures. During an electrode session, magnetic electrodes are attached to problem areas. In the second method (needle electrolipolysis), needle-electrodes are inserted into the subcutaneous fat to a depth of five millimeters. This is a painful process that is fraught with swelling and redness. However, it is thirty percent more effective than the electrode method.

An electrolipolysis session consists of several successive stages and lasts about an hour. The first stage is lipolysis itself; the second - electrolymphatic drainage; the third is toning. During the procedure, the client feels a slight tingling sensation.

A course of electrolipolysis includes from five to ten sessions, depending on the stage of cellulite or the amount of subcutaneous fat. The interval between procedures is at least a week.

Cavitation adipocytolysis (ultrasonic cavitation)

The cavitation method is based on the use of low frequency ultrasound in the range of 38-42 kHz, which causes an acoustic wave that forms microvoids (bubbles) in the liquid. Bubbles, moving in areas with different pressures, change their sizes, some of them burst, causing a shock wave and the release of a large amount of energy. Adipose tissue contains a large amount of fluid. Cavitation bubbles are able to liquefy the contents of the adipocyte and displace triglycerides from the cell. Some of the bubbles burst, producing a micro-explosion in the adipocyte, damaging the cell membrane and actually damaging the fat cell. The surrounding tissues - skin, blood vessels, muscles - are not damaged during the procedure, as they have different physical characteristics.

Metabolic products from destroyed and damaged cells enter the intercellular space and are excreted through the lymphatic and circulatory systems. In some cases, to increase the effectiveness of ultrasound, lipolytic cocktails or saline are injected into the areas to be treated before the procedure.

Cavitation is effective, but is not an express method. To obtain a visible lasting result, a course of 3-6 procedures is required with an interval of 5-8 days. In a 40-minute session, an area of the body with an area of 25 by 25 cm is treated. The procedure is painless and comfortable for the client.

Radio wave lipolysis (RF lipolysis)

Another popular non-invasive hardware method for correcting the manifestations of cellulite and LVAD is RF exposure. During the procedure, radio frequency energy, without injuring the epidermis, reaches the deep layers of the dermis and subcutaneous fatty tissue. Deep and uniform heating of the dermis promotes increased microcirculation, the synthesis of heat shock proteins and, as a result, retraction of existing collagen fibers and stimulation of neocollagenesis. At the level of subcutaneous fatty tissue, softening of the connective tissue septa, acceleration of the processes of lipolysis and elimination of fatty acids from adipocytes are observed. Although radiofrequency exposure does not directly lead to the destruction of fat cells, this procedure is in demand in combination with other lipolytic and drainage techniques, as it potentiates their effects and additionally helps to improve the quality of the skin and the lifting effect in the affected areas.

The course of procedures is 8-10 sessions with an interval of 1 week between procedures. Procedures using radio waves are pleasant for the client.

In practice, a course of procedures has proven itself well, in which sessions of radiofrequency exposure and ultrasonic cavitation sequentially alternate. Recently, devices have appeared on the cosmetic market that combine these two techniques on one platform.

Cryolipolysis

Cryolipolysis is a new promising method for reducing local fat deposits, which is based on long-term cooling of subcutaneous fat tissue (SFA). Under the influence of low temperatures, the processes of apoptosis—programmed cell death—start in the PFA. Selective programmed death of adipocytes, without damage to neighboring histological structures, is associated with the low ability of cells of this type to adapt to a decrease in ATP synthesis (which is observed during prolonged cooling of moderate intensity). Unlike necrosis, apoptosis does not involve the release of cellular contents and the development of an inflammatory reaction. The process involves a single cell.

To effectively cool sebum, some cryolipolysis machines have a vacuum applicator that draws in the fat fold and presses both sides of it against the cooling elements. The skin does not come into direct contact with the cooling elements, as it is covered with a special gel cloth that dissipates heat evenly.

The process of cooling and exposure to vacuum is controlled by the device itself. Treatment of one zone takes up to 60 minutes. Typically, symmetrical areas are treated in 1 session. During the procedure, the patient feels moderate cold at the point of contact of the applicator. As a result of one procedure, the volume of adipose tissue in the fold is reduced by 25-30% within 1-3 months. It has been proven that more striking results are achieved by sequentially combining the cryolipolysis procedure and manual or hardware massage of the treated area in one session.

Laser lipolysis

There are two types of laser lipolysis: cold laser lipolysis and laser liposuction.

The first technique is based on cold diode laser technology using 660 nm red spectrum radiation. This light is actively absorbed by adipocyte lipases, triggering a series of biochemical reactions, as a result of which the contents of fat cells are liquefied and removed through an intact membrane into the intercellular space. This type of treatment is effectively combined with vacuum therapy, phonophoresis, electroporation and shows good results, primarily in the fight against cellulite and silhouette correction.

To combat local fat deposits, laser liposuction is more often used. This is the latest minimally invasive technique for removing fat from small areas of the body, such as the face, abdomen, buttocks, and knees. Classic surgical liposuction uses a tube that is inserted under the skin to remove fat mass. Manual suction may cause tissue destruction and swelling. Laser liposuction can melt fat cells before they are pumped out, which significantly reduces the invasiveness of the procedure.

Modern devices allow you to treat problem areas in one of three modes:

• combined (924/975 nm) - for lipolysis with simultaneous contraction of skin tissue;
• with a wavelength of 924 nm - for lipolysis in its pure form;
• with a wavelength of 975 nm - for skin contraction.

Laser liposuction is performed by a plastic surgeon on an outpatient basis without general anesthesia (only local infiltration is used) and involves minimal trauma to the skin. The procedure uses a thin fiber-optic laser probe that is inserted under the skin. This technique can be used in cases of severe fibrosis. The use of modular laser equipment eliminates blood loss and the occurrence of hematomas due to the simultaneous coagulation of blood vessels.

The duration of the procedure depends on the volume of adipose tissue to be removed, as well as on whether pumping out of the destroyed fat after laser lipolysis is used. On average, the procedure lasts from 20 minutes to 1 hour. Most often, one laser lipolysis procedure is sufficient, but it all depends on the volume of fat and the wishes of the patient. After the procedure, there is no need for observation in a hospital, the patient does not have to change his usual lifestyle, natural physical activity is allowed.

So…

Aesthetic medicine offers many effective methods to combat local fat deposits. At the same time, it is well known that the process of getting rid of excess fat deposits is always associated with a load on all body systems. The result of “thoughtless” liposculpture can be:

• intoxication;
• disruption of the gastrointestinal tract;
• swelling;
• loss of skin tone;
• premature aging;
• rapid weight gain;
• decreased immunity;
• development of cardiovascular diseases.

The combined use of liposculpture procedures aimed at draining, detoxifying the body, increasing microcirculation in adipose and muscle tissue helps to avoid adverse consequences and achieve a good and lasting result. Such procedures include mud wraps, manual massage techniques, mesotherapy, pressotherapy, vacuum therapy, endermology, myostimulation, electroporation and phonophoresis using drainage and lipolytic agents and other techniques.

The methods of lipolysis and liposuction described above are aimed at combating LVO in people without signs of obesity and are not methods of weight loss, but can be used in complex weight loss programs in conjunction with diet therapy and dosed physical activity, and changes in the client’s lifestyle.

First published in the magazine “Cosmetologist” No. 6, 2016