Q: I am 24 years old and have familial multiple lipomatosis as my father has it. I have multiple lipomas (relatively small) in arms, trunk and thighs and some of them cause me pain. Looking for excision of the lipomas which number about a dozen. I don’t know who exactly to go to or what to do. I’d appreciate it.
A: While many people have single or isolated lipomas, a few patients will have many more than one and lipomas that continue to occur over their lifetime. This is a condition known as familial lipomatosis. No one understands why it occurs or what causes it. Since there is no definitive cure for this recurrent problem, it is usually best to wait until there are enough symptomatic (painful) ones that justify surgical removal. There is an injectable treatment which is best reserved for those that are smaller and not near any important structures such as nerves. Injecting can help suppress their growth and may for some small lipomas be curative of them. Otherwise, intermittant excision will be needed as their numbers and size dictate.
Dr. Barry Eppley
Q: I have 5 lipomas in my stomach area and would love to have their size reduced, if not completely gone. I’ve been looking into having them treated by deoxycholate injections. What has been your success in getting rid of them (all of them are less than 4 cm in diameter) and how many injections sessions does it usually take?
A: The traditional method for lipoma removal is excision. These are encapsulated benign fat tumors that actually pop out of small incisions made directly over them fairly easily with a little pressure. But in an effort to avoid surgery, the use of fat-dissolving injections has been done for them as well. Known chemically as deoxycholate or phosphatidylcholine deoxycholate (often called Lipodissolve), this solution has been well described for the cosmetic reduction of small body fat collections. Working through an inflammatory process, this solution is known to break down the cell walls of fat allowing their fatty acid content to be released. It is less well described and known for fatty tumors (lipomas) treatment but it works through a similar inflammatory process. The fat in a lipoma is more densely packed and , in theory, is a little more resistant.
I have treated a series of lipoma patients with these Lipodissolve injections in my Indianapolis plastic surgery practice and do find it to be effective. It does take more than one injection session to get maximal reduction in most patients. How many injections sessions that would be depends on the size of the lipoma. As a general rule, expect about a 50% reduction with each injection session.
Dr. Barry Eppley
Q: I have multiple lipomas over my arms and legs. Is there anything new to having them removed?
A: The standard treatment for lipomas remains excisional, making a small incision over the lipoma and pushing it out. While effective, this does result in a very small skin scar. While this approach is fine for several or even up to ten or so lipomas, it is tedious and results in many fine scars.
An alternative non-surgical approach is Lipodissolve injections. A needle is used to inject each lipoma with about a .5ml solution of phosphatidylcholine and deoxycholic acid. This is a fat dissolving solution that will shrink the size of the lipoma and in some cases get rid of it completely. Usually, however, it takes more than one injection to be assured of its complete eradication. If you are seeking a truly non-surgical approach, these injections are a treatment to be considered as long as one understands that more than one injection may be needed for maximal results.
Another ‘minimally-invasive’ approach is spot laser treatment. Using a Smartlipo (laser liposuction) fiberoptic probe, a nick is made in the skin and the probe is inserted next to or into the lipoma, it is turned on and used to heat up the lipoma until it is melted or destroyed. Like excision, this does require a local anesthetic.
Dr. Barry Eppley