The effectiveness of injection lipolysis in the fight against fat deposits

Igor Rudenko , dermatovenerologist, Senior Clinical Research Physician, ICON (Germany)

Obesity is a disease that leads to disruption of a number of functions and significantly limits the patient. Sometimes even minor local fat deposits (LAD) motivate a person to contact a specialist who works with the body.

Weight loss techniques are quite in demand in cosmetology - sometimes they are among the most popular in clinics. What people do to get rid of excess weight! However, for most patients, the choice of liposuction is frightening: they are afraid of anesthesia, complications, pain, a long recovery period, uneven skin, and hyperpigmentation. Therefore, non-surgical methods for reducing adipose tissue are of increasing interest.

These methods are simple to perform, minimally invasive, do not require complex rehabilitation and can be performed on an outpatient basis or in a one-day hospital setting. These include cosmetic wraps, various hardware procedures such as cryolipolysis , cavitation (shock wave therapy), lipolytic massage, as well as injection lipolysis . The latter method is the most widespread and is especially popular due to its relatively low cost, good effectiveness and high safety profile.

Features of injection lipolysis

The idea of injection lipolysis arose more than 15 years ago, when the first drugs for cellulite mesotherapy appeared. In the process of working with this technique, the indication areas have expanded, and now not only the hips are treated, but also areas of local fat deposits, including on the anterior abdominal wall, iliac crest and sacrum, fat pads on the lateral surfaces of the torso, thighs, buttocks, etc. the area of the "breeches" and knees, pre-axillary areas, in the area of the menopausal hump, as well as the double chin. Procedures began to be carried out also to correct insufficient results of liposuction, especially when it is necessary to smooth out the skin texture.

Very soon it turned out that working with lipolytics such as phosphatidylcholine, triac, L-carnitine does not produce a local lipolysis effect. Only one of the “players” ultimately proved its effectiveness as a local lipolytic – deoxycholic acid, or deoxycholate.

Sodium deoxycholate (deoxycholic acid, SHA) belongs to the group of secondary bile acids. Recent studies show that it is sodium deoxycholate that is responsible for the lysis of adipocyte membranes in cell culture. It causes disorganization of cell membranes, cell lysis and thereby creates chemical destruction of adipose tissue.
The effectiveness of injection lipolysis depends on many factors:

• hormonal status (insulin / contrainsular hormones);
• condition of subcutaneous fat;
• nutritional status;
• injection technique;
• dosage;
• related procedures.

The results are more striking if injections are performed into the so-called soft fat, that is, in an area where there is no pronounced swelling and tissue fibrosis. The most successful areas for correction are the upper and middle third of the anterior abdominal wall, the lateral ridges on the torso, the pre-axillary areas, and the double chin. Although menopausal hump is treatable, it is prone to recurrence. The effectiveness of procedures in the back area, in the lower third of the anterior abdominal wall, and on the inner thighs is somewhat lower.

Dangerous areas of correction include the inner surface of the shoulder, since when performing injections in this area, there is a high probability of getting extensive hematomas, widespread swelling, pain and discomfort. Also, in our opinion, it is dangerous to perform injections in areas of accumulation of infraorbital fat due to the high risk of developing necrosis and hematomas in this area.

Technique of intralipotherapy

The intralipotherapy session is carried out in the treatment room in compliance with all the rules of asepsis and antisepsis. The doctor performs the injections wearing sterile gloves, and the skin of the injection area is treated twice with a disinfectant solution (chlorhexidine, 70% alcohol).
There is a practice of diluting one bottle of the drug with a solution of lidocaine 2% (0.2 ml). This somewhat reduces pain during the injection. The drug is injected strictly into the subcutaneous fatty tissue using special flexible needles of 24 and 25 G caliber and 10 and 7 cm in length.
Before the procedure, with the patient in a standing position, the injection area is marked and a point for inserting the needle is identified, allowing the entire planned area or most of it to be treated. The work is carried out in a fan method, with a minimum number of injections. Minimizing needle insertions, together with other factors, reduces the risk of infectious complications.
The drug is administered to a depth of about 1.5 cm (to be specified depending on the area and nature of fat deposits) in a linear-retrograde manner using a fan technique. Bolus administration is excluded.

Post-procedure care

The doctor should warn the patient that after the procedure he needs to consume approximately 1.5-2 liters of fluid daily to activate drainage processes and detoxification (sometimes the state of intoxication on the first day after the procedure is called “flu-like syndrome”). The daily calorie content of food during this period should not exceed 1,200−1,500 kcal. Antioxidants, sources of microelements, and polyunsaturated fatty acids should be included in the diet, and the consumption of carbohydrates and refractory fats should be sharply reduced.

In addition, it is undesirable to wear tight clothing that squeezes and rubs the injection sites. However, when correcting the hips, torso and submental area, it may be recommended to wear compression garments.

Skin care in the injection area in the first 3−7 days after the procedure includes the use of external therapy with anti-edematous, anti-inflammatory and angioprotective effects, and in case of pronounced inflammation (developed hyperemia, pain, swelling, increased local tissue temperature), cold wraps can be recommended, cryotherapy, microcurrents. In case of emergency, it is permissible to take non-steroidal anti-inflammatory drugs and/or analgesics.

To improve the excretion of lipolysis products, hepatoprotectors, enzyme preparations, and means for improving blood microcirculation are recommended; the use of hardware lymphatic drainage procedures (LPG), carboxytherapy and ozone therapy is also justified. Subsequently, you can use traditional anti-cellulite creams and gels containing nicotinic acid and caffeine, and carry out mud wraps.
During the week after the procedure, you must avoid visiting the solarium, bathhouse, sauna, or gym.
If complications occur - high temperature (more than 37.8 ° C), throbbing pain at the injection sites, severe asymmetry, prolonged persistent swelling and redness of tissues, severe intoxication - the patient should immediately consult a doctor.

results

The effect of the procedure is assessed after 1 month. The recommended course is 4 procedures with a frequency of 1 procedure every 4 weeks.

Although injection lipolysis procedures do not replace liposuction, chemical destruction of a limited volume of adipose tissue, especially in areas inaccessible to liposuction, if patients have contraindications to surgery and in other clinical situations, is the method of choice.

Whether to get rid of local fat deposits or not is an individual matter. The main task of the specialist in this case is to advise and properly prepare the patient, ensure the safest and most comfortable procedure, and also help in the rehabilitation period to obtain the maximum effect.

First published: KOSMETIK international journal, No. 1 (55)/2014