Q: Dr. Eppley, I am 47 years old with multiple lipoma on both the hands, back, stomach, and thighs with more than 100 lumps. Even my brother has it. Recently I underwent Vaser lipo for lipoma treatment on both the arms. I know it may reoccur but for the time being I am happy with the results. Still I have many lipomas on my back, thighs etc.
My question is there any research being done for non invasive treatments. What is best for multiple lipoma treatment as on today? What can we expect in near future ?
A: In the treatment of solitary or, more pertinently, multiple lipomas in familial lipomatosis as you have, I know of no ongoing research that is looking at how to best treat them. Current treatment options include open excision, laser lipo probe ablation, various liposuction options and lipodissolve injections. All of these methods have variable effectiveness and, other then open excision, the effectiveness of one over the other is unproven.
Dr. Barry Eppley
Q: Dr. Eppley, I am a 27 year old male. I am in good shape and workout all the time. I have lipomas all over my body and have had four surgeries to remove them. I have always had excision. I now have near 100 scars and would like to figure out another option for myself. I have read about your practice and wondering if you could help. I have done a little research on fat dissolving injections. I would prefer not to have as many scars as I do now, but I know that surgery is the best option. So far I have had four surgeries and have removed about 90 small lipomas. I don’t understand why I get them as I am very healthy and in good shape. I exercise regularly and eat a well balanced diet. I would prefer the injections if you feel it is worth my time and money or a possible liposuction technique. I’m not against excision but would prefer no more scars. Thank you for getting back with me.
A: The condition that you have is known as familial lipomatosis. There is where someone, like you, develops recurrent and new subcutaneous lipomas all over their body. It has nothing to do with your weight, diet or exercise habits. It is a genetic condition where these lipomas develop and no one understands the cause and how to control it. All that can be done is selective removal of the most problematic lipomas. While surgical excision is the established and most definitive treatment for lipomas, it can certainly be taxing to undergo recurrent surgeries for them. Lipodissolve is a generic name for the injection of a known fat dissolving solution that contains phosphatidycholine, deoxycholic acid or various combinations of both. This is a compounding pharmacy injection not an FDA-approved drug. (although it is currently under current phase II clinical trials by Kyphera for neck fat reduction) This approach for fat reduction achieved notoriety in the mid-2000s when it was widely used across the U.S. for cosmetic body contouring and fat reduction. Its use collapsed when the company promoting it collapsed and the FDA stepped in and stopped its widespread use as an unregulated cosmetic treatment.
When it comes to the use of these injections for lipomas, I have used them in numerous patients with reasonable success. It does shrink them by fibrosis and scarring. It may take more than one injection session to get the maximal reduction. The lipomas may or may not regrow based on their original size and how much reduction is obtained.
Dr. Barry Eppley
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.