Your Questions

Q: Dr. Eppley, I am interested in a Smartlipo laser liposuction procedure. I have a fatty tumor behind my arm and would like to remove it with the least invasive procedure. I also have fatty tumors in my legs which would love for them to be gone also.

A: Smartlipo or laser liposuction is one possible treatment approach for smaller lipomas. While all of these lipomas could be simply removed by excision, I could understand why you would not want the fine line scars. What is important to understand is that treating them by Smartlipo/laser liposuction is not quite the same as removing traditional unwanted fat. Unwanted fat is soft non-encapsulated fat that extracts easily and thoroughly after being partially liquified by the laser energy by small cannula liposuction. In contrast, lipomas are well encapsulated ‘balls’ of fat that are really benign tumors. The laser energy may break them up into small pieces but it does not necessarily liquify them completely and thus they are not as easy to extract by liposuction. The point being is that the laser liposuction treatment method of lipomas is best viewed as a reduction method that may or may not result in them being completely removed.

Dr. Barry Eppley

Indianapolis, Indiana

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