Doctors warn against lipo-dissolve, but fans say it works

Beauty sometimes demands toughness, as many women discover, but Suzanne Thomas had never imagined she would agree to have 72 injections of a fat-burning chemical cocktail in her neck and chin.

Yet that is the treatment called lipo-dissolve that the 35-year-old teacher underwent — twice — several months ago to eradicate jowls and a double chin. Thomas said the discomfort was worth it because "I absolutely love my results." The procedures, which cost a total of $1,000, were performed at MedSculpt, a six-month-old center in Rockville, Md., that specializes in the controversial fat-loss technique.

Marketed as a safer and less invasive alternative to liposuction, proponents say lipo-dissolve is useful for treating small "problem areas" such as love handles, bra fat and a softening jaw line. A growing number of doctors, nurses and even spa personnel are offering the procedure known in medical circles as injection lipolysis — and colloquially as the "flab jab."

But critics, among them officials of the American Society of Plastic Surgeons, the American Society of Dermatologic Surgery and the American Society for Aesthetic Plastic Surgery (ASAPS) say there is no convincing evidence that lipo-dissolve is effective — or safe — and they warn patients to stay away from fat-loss shots.

The procedure is similar to mesotherapy, an older treatment that involves injections of various drugs, vitamins or herbs to banish cellulite. Lipo-dissolve injections typically contain two ingredients believed to work synergistically. As with mesotherapy, the formula, which is not approved by the Food and Drug Administration, is prepared by compounding pharmacies, which are subject to little regulation.

Lipo-dissolve "is catching on because it works," said Robert Adrian, a dermatologist, who says he has treated 400 patients in the past three years. Adrian, whose Web site says the procedure "literally melts away fat in just a few short treatment sessions," maintains that most of his patients have achieved good results.

Officials of ASAPS, whose membership includes cosmetic dermatologists and plastic surgeons, disagree. Fat-loss injections, the group cautioned recently, are "scientifically unproven," lack approval from the FDA and use "poorly defined ingredients." The group cited "numerous reports of complications ... including bacterial infection, granulomas (disfiguring masses of chronically inflamed tissue) and localized necrosis (tissue death)." To assess its safety and efficacy, the society is sponsoring a small placebo-controlled study of the procedure under the supervision of the FDA.

Medical experts aren't the only ones who have reservations. Kansas recently became the first state to regulate the treatment, sparked by concerns about the rapid proliferation of clinics and spas performing lipo-dissolve and the qualifications of practitioners.

"There is no real evidence that this is an advance over snake oil," said Alastair Carruthers, a clinical professor at the University of British Columbia in Vancouver. What some proponents tout as impressive results, he said, appear to be temporary.

Safety remains a big concern, according to Carruthers. He treated a woman who nearly lost both lower eyelids after she developed a potentially sight-threatening complication following lipo-dissolve injections administered by a physician. The shots killed tissue under her eyes.

Lipo-dissolve typically contains a mixture of phosphatidylcholine, which is derived from soybeans, and sodium deoxycholate, a bile salt that aids waste removal.

This cocktail, often dubbed "PCDC," is prepared in compounding pharmacies, which typically make small quantities of drugs for specialized treatments. Quality control and sterility can be spotty or nonexistent, experts say.

Using a fine needle, the PCDC solution is injected into fat deposits, typically in the abdomen, face, hips or back.

For large areas, as many as 120 injections may be required at one time. Sometimes the shots are administered using a rapid-fire instrument called a "mesogun" rather than a syringe.

PCDC shots cause temporary burning and swelling. (See user comments at www.realself.com) The injections are believed to trigger an inflammatory response that results in the breakdown and excretion of fat; proponents say how this occurs is unknown. Two to six treatments are required, each of which run $300 to $1,500.

Michael Olding, chief of plastic surgery at George Washington University Medical Center, said it is still unclear what's in lipo-dissolve. "There is no accepted standard of what is included in these injections," he said.