Q: Dr. Eppley, I am interested in facial fat removal after fat grafting. Two months ago I had fat injected to my bottom cheeks (30 ccs of fat) and the result was horrible! Is there a way to remove this fat? Would be difficult to remove it all? Won’t be there any side effect resulting from the liposuction? And what about Lipodissolve (phosphatidylcholine), does it help melting out the fat? Would Lipodissolve eventually at the end of the required sessions would melt the unwanted fat? Unlikely liposuction, lipodissolve can be injected to muscles, right? Actually I am desparate and am going through a very difficult time because of my face and want to remove/melt as much of the injected fat as possible. How many sessions of Lipodissolve do you think I might need? And how long should I wait to get my old look back?
A: Thank you for your inquiry and sending your picture. Most likely some of the fat can be removed by small cannula liposuction. (microliposuction) It is important to realize that all of the fat may not be removeable. If some of the fat is on the muscle then that portion can not be removed. One must also be careful to refrain from too aggressive liposuction is this area to avoid injury to the buccal branches of the facial nerve.
The use of fat melting solution like phophatidylcholine (aka Liposdissolve injections) is that their effects are unpredictable and will require mutiple injections sessions to do so. For one week after each injection session the treated area will be swollen and double in size. There is no assurance that any chemical method can get rid of all of the fat. It is unpredictable. You never inject Lipodissolve solutions into muscle unless you want to potentially damage facial muscles as well.
It is also important to realize that the Lipodissolve solutions used in the past were made by compounding pharmacies and were not FDA-approved. The only true Lipodissolve solution that exists today is known as ATX-101 and is under clinical trials by the FDA and is not currently available for patients outside of the clinical trials. (it is only being tested for the reduction of submental neck fat) It will likely be fully approved for general patient use in later 2015 or early 2016. Thus there is little reason to continue the pursuit of Lipodissolve injectiojns as it is not available currently. (unless one wants to use unapproved solutions from compounding pharmacies)
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in fat injections (Lipodissolve) for my lower abdomen. I am done having children and have gained an excessive amount of weight during my pregnancies. I have lost the weight, but the aftermath is stretch marks, loose skin and a “pudge.” My upper abdomen has no stretch marks and is ok. I am trying to find an affordable procedure, that I can handle with minimal downtime, as I have 2 small children.
A: What you need, without even seeing a picture of you and based purely on your rather classic description, is not going to be achieved by an injectable fat reduction technique. Lipodissolve is intended for very small fat collections (like the neck) in which the overlying skin is of good quality. It is completely ineffective for the post pregnancy belly that you are describing. What you need is some form of a tummy tuck which can more effectively deal with the excess/loose skin and fat. With this type of abdominal problem, you either hold out for a tummy tuck one day or do nothing…as nothing will offer any acceptable level of improvement.
Dr. Barry Eppley
Q: Dr. Eppley, I would like to find out if I am an appropriate candidate for lipodissolve. I had a tummy tuck about 7 years ago and do not wish to have another surgical procedure. I have always had issues with my flanks.
A: While I obviously do not know what your flanks look like, I highly doubt they could be signficantly improved by Lipodissolve injections. That is a fat reduction technique that has largely faded from use due to limited effectiveness. I still use it occasionally for small revisions after liposuction surgery but it is too ineffective an
d inefficient to treat laregr fat areas. You may consider other non-surgical alternatives such as Exilis radiofrequency treatments which have been shown to be more effective than these old-style fat injections. But whether even this approach is appropriate would depend on the size of your current flanks. I would encourage you to come in for a free consultation to find out the advantages and disadvantages of both flank liposuction and Exilis treatments to the flanks.
Dr. Barry Eppley
Q: Dr. Eppley, I have a fatty area on my very upper inner thighs that is always rubbing even though the rest of my legs are fairly muscular. I also have an area of fat between my breasts and armpits that I cannot stand. I exercise daily and these problem areas are never resolved. Do you think Lipodissolve would be beneficial? Thank you.
A: Thank you for your inquiry. In answer to your question, I do not think that Lipodissolve would be the way to go for all of those fatty areas. Lipodissolve requires a series of injections, which cause swelling and discsomfort for a week afterwards. It would take three or four injection sessions spaced four to six weeks apart to see results. With multiple fat areas you would find that process slow and mildly unpleasant, in essence an inefficient fat reduction method whose results are uncertain. While it is a non-surgical treatment, it just won’t work well for what you want to achieve. It would be far better, achieving more efficient and effective fat reduction, to undergo a one hour Smartlipo procedure under anesthesia. This may be exactly what you want to avoid but you would also want whatever treatment is chosen to work as well. Interestingly, a one hour liposuction procedure will actually cost less and have a quicker recovery than a series of Lipodissolve injection sessions.
Dr. Barry Eppley
Q: I am interested in trying to get my face to look less fat. I want to make my face slimmer if possible. I have a small double chin and fatter cheeks and jowls. I have read about Lipodissolve injections and this seems like a good and easy solution for my small areas of facial fat as I know these injections are for small areas and not big ones. Do you think this will work for me?
A: While Lipodissolve injections can provide some minor benefit in fat reduction in the neck and jowl areas, they require three or more injection sessions (spaced 4 to 6 weeks apart) to get the best result. After each injection session, the treated areas will double or triple in size for one week as part of the inflammatory by which it breaks down the fat. . Because of this socially visible recovery, most patients will opt for a more effective set of procedures that actually has less total recovery even though it is surgery. I would recommend a combination of submental, jowl and lateral face liposuction and buccal lipectomies. This reduces all available fat compartments in the face that can easily and safely be treated. This is is the best way to get a slimmer face through fat reduction. It has less recovery than Lipodissolve injections because the swelling is only one time and is largely over after a few weeks.
Dr. Barry Eppley
Q: I have been developing droopy jowls over the past few years and it is getting worse. I am 50 years and I don’t want a facelift or surgery. Is there anything that may help them go away that doesn’t involve any cutting and scars? I have read about some fat dissolving injections which they say can make jowls get better. Is this true?
A: The development of jowls or jowling will occur in everyone eventually. These classic aging signs are when the skin and fat that used to be up on the side of the face comes sliding down due to time, gravity, and weakening of the skin’s attachments. There is no question that the preferred as well as superb treatment for isolated jowling is some form of a facelift. If jowling and not the neck is the main issue, then a more limited type of facelift will work quite well. These smaller facelifts (jowl lifts or tuckups) go by many different names, most popularly known as a MAC Lift or a short scar facelift. Regardless of the branded name, they are all essentially the same type of limited facelift operation.
Short of surgery, fat dissolving injections have been used for mild jowling. Known as Lipodissolve injections, these chemical concoctions do have the ability to break down small areas of fat and tighten just a little bit of skin. I have used them very rarely in the jowl area but, in the handful of cases that I have done, there was a definite amount of improvement and several of those patients were absolutely thrilled. The key is in patient selection. They must not have too much loose skin or too much jowling or these injections will have no benefit.
There are also other device-driven methods of jowl tightening such as Thermage, Skin Tyte and others. The concept is to treat the deeper skin and underlying tissues with heat, ultrasound or radiofrequency energy to create the tightening. These device approaches to jowling would be more mainstream and accepted as opposed to Lipodissolve injections.
Dr. Barry Eppley
Q: I had a baby about 16 months ago and still have a little pooch I cannot get to go away. I am interested in finding out about whether lipodissolve, smart lipo, and liposuction and seeing which one may be best for me.
A: Pregnancy does one thing that works against the effectiveness of any fat reduction method alone…it changes the abdominal skin. By stretching out the skin and losing some of its elasticity for most women, the abdominal pooch problem is often a combination of extra skin and fat.
It may be possible that liposuction (Smartlipo or traditional) alone will provide a satisfactory result for that abdominal pooch. But in most cases it has to be combined with some form of skin removal, maybe just a mini-tummy tuck will suffice.
One observation about Smartlipo that has become apparent to me over the past year is its apparent confusion as being different than traditional liposuction. Smartlipo is still liposuction and is invasive. It is simply a different and improved method of initially melting and loosing the fat before it is suctioned out. For whatever reason, patients often mistakenly think that Smartlipo is not surgery and is not liposuction.
The use of fat-dissolving injections for body fat removal has largely been relegated to a non-role in body contouring today. Despite its popularity from several years ago, it has failed to live up to the results we had hoped. While it can have some effectiveness, the fat areas must be quite small. Even in small areas, the use of Smartlipo under local anesthesia produces better results in a single stage procedure.
Dr. Barry Eppley
Q: I have multiple lipomas along nerves in my arm and am interested in finding out how to get injections to decrease their size. These lipomas give me pain because they are up against my ulnar nerve. I have about 80 lipomas all over my body. I am female, fit, 35, and frustrated with surgeries to remove them.
A: While the benign fatty tumor, known as a lipoma, are common soft tissues masses seen, multiple or many lipomas that recur in a patient is uncommon. When large numbers occur, they are as familial lipomatosis. Throughout one’s life new ones continue to grow and develop. Modern medicine does not have an explanation for why they develop or what causes them.
While I have had positive experiences with Lipodissolve in the treatment of more superficial lipomas, I would have concerns about injecting near a motor nerve. There is the distinct possibility that permanent damage may occur to the nerve, causing forearm and hand dysfunction. That is a risk that would not be a good trade-off.
Lipodissolve remains a non-FDA approved treatment method for any type of fat removal or shrinkage. It is not even a pharmaceutical-grade chemical as it is made through compounding pharmacies. While widely used as a cosmetic treatment for ‘dissolving’ fat, its use as a lipoma injection treatment has never been scientifically evaluated in any clinical trial method although anectodal reports exist that attest to its effectiveness.
If these ‘lipomas’ in fact do involve or are connected to the nerves, they may well be neuromas or neurofibromas which would not be responsive to fat-dissolving injections anyway.
Dr. Barry Eppley
Q: I have numerous small lipomas on my forearms and legs. How effective is lipossolve on these?
A: Lipomas are benign fat tumors that develop for unknown reasons. It is common that one may eventually develop one or two lipomas over their lifetime. Usually they are small and can develop anywhere from the scalp down to the legs. I have never seen them in the hands or feet, probably because there is very little fat there. They are harmless but sometimes they can be uncomfortable. Rarely, a patient may present with multiple and newly developing lipomas at several different areas of the body. This is known as a condition of familial lipomatosis in which the patient will continue to develop many (dozens to hundreds of lipomas) throughout their lifetime.
Lipomas are easy to remove surgically and they can literally ‘pop out’ through a small incision. But they will leave a small scar from the incision and, at the least, require a local anesthetic for removal. Depending on where they are located and how big they are, they may require more than just a local anesthetic. If there is only one or two, then surgical removal is reasonable. When one has many, surgery becomes more arduous and less appealing. Liposuction is not an option for lipomas.
There is no proven or FDA-approved method of injectable lipoma treatment. The chemical concoction, known as Lipodissolve, has had widespread use for injectable fat reduction for cosmetic purposes over the past decade. Because it is intended for fat lipolysis (dissolving), it is no surprise that it has been reported to be used for the non-surgical treatment of lipomas. It is simple and quick to do and, in my limited experience of a handful of patients, has been effective. It may require more than one injection to make the lipoma go away but most of the time it will work. There will be the typical swelling of the injection site for a week or so after treatment.
Potential patients needs to understand that neither the solution or treatment method have ever been through formal FDA testing and evaluation. Reports of its use and effectiveness for lipomas are anectodal, not scientifically proven.
Dr. Barry Eppley