Your Questions

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

Indianapolis, Indiana

Q:  Dr. Eppley, I have gained 40 lbs since I had a hysterectomy seven yrs ago. My stomach is now extremely out of portion to the rest of my body. I need to ge rid of this as I believe it’s very unhealthy. I lack disciple in terms of appetite or taking diet pills. I am interested in fat injection treatments,  Will insurance cover any type of non-surgical treatment to reduce my stomach fat?  What is your input on this fat treatment method?

A:  In terms of getting rid of a stomach bulge, no matter how large it is, is not something that would be covered by insurance regardless of the method of treatment. When you speak of injections for reduction of fat you are undoubtably referring to Lipodissolve, a blend of phosphatidylcholine and deoxycholic acid solution. While this can help reduce very small collections of fat, it is not going to be effective for a fat collection of any size. While it was very popular several years, it has fallen out of use because it has proven to be ineffective for abdominal fat collections that many people want reduced. I still use it occasionally but only as a treatment for small postoperative liposuction ‘high spots’. Unfortunately what you are seeking is a non-surgical solution to a surgical problem…and that does not exist. 

Dr. Barry Eppley

Indianapolis, Indiana

Q: I have approximately 30 lipomas on my arms that range from a large pea to an almond to a large marble.  On my rib cages and abdomen are about a dozen the size of walnuts, and on my legs there are too many to count and of the same various sizes. I am a 45 y.o. female that has always taken pride in eating healthy and being overweight no more than 5 to 10 pounds. I was physically very active, an avid runner, and love to mountain hike. In the past two years the lipomas have erupted in such great quantities all over my body that my life has changed and taken away much of the life that I enjoy. I know that these lipomas can be cut out but that would leave so many scars that it would be horrible and maybe just as bad as the original problem. Are there any new methods for lipoma removal that would not leave so much scarring?

A: With so many lipomas, you obviously have the condition of familial lipomastosis. While you have many now, this suggests that there are more to come in the future. Besides excision (cutting them out), there are not any other conclusively proven methods of lipoma removal. However, I have found some success with both Lipodissolve injections and spot Laser Liposuction (Smartlipo) treatments. Lipodissolve injections cause an inflammatory reactions within the lipoma that causes it to shrink. Most of the time, it takes more than one injection session to get ti to go completely away. Laser liposuction treatment uses the tip of the laser probe to melt the lipoma. Through a small stab incision, the probe is inserted into the lipoma and it is turned on until the lipoma begins to melt.

With so many lipomas, I suspect that the combination of excision, Lipodissolve injections, and laser probe treatments may be needed based on their size and location. Given the multiple locations, all of this could be done in a single outpatient procedure done under general anesthesia. That would be the most comfortable way to treat all of them in a single setting.

Dr. Barry Eppley

Indianapolis, Indiana

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

Indianapolis, Indiana

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