Thursday, June 28, 3 p.m.

Does Lipo-dissolve Work?

Dr. Michael Olding
Chief of Plastic Surgery, George Washington University
Thursday, June 28, 2007; 3:00 PM

Can shots safely dissolve fat deposits? Dr. Michael Olding was online Thursday, June 28 at 3 p.m. to take your questions about the safety and effectiveness of lipo-dissolve treatments.

A transcript follows.

Dr. Olding is Chief of Plastic Surgery at The George Washington University and Director of the Cosmetic Surgery and Laser Center at GW.


Washington, D.C.: I am so glad you are having this discussion since I have been looking into having lipo-dissolve done. But my question is, how does one know what's the best choice to have done, liposuction or lipo-dissolve or even a tummy tuck? How does one find the best doctor to perform? Thanks.

Dr. Michael Olding: ALWAYS look for a board certified plastic surgeon or other physician speciality approved... and this is important .... by the American Board of Medical specialities.. Lipo dissolve is NOT approved by the FDA. Liposuction is. The proponents of the lipodissolve procedure (and I am not one of them) indicate that it is ONLY for small areas... Tummy tuck (abdominoplasty) is necessary if there is excess fat and/or skin... often after having children.


Lothian, Md.: Can lipo-disolve cause the dimpling affect that traditional lipo can cause?

Thank you.

Dr. Michael Olding: Dimpling in the skin usually occurs even without any type of liposuction at a certain age because the skin becomes inelastic. If traditional liposuction will cause dimpling... and it only causes dimpling in patients who are not good candidates (ie ones that have loose or tethered skin)... The more elastic your skin the better the candidate.(I would preseme that is also true for lipodissolve)


Washington, D.C.: Dr. Olding, an excerpt from the article pertaining to this procedure is as follows:

Fat-loss injections... The group cited "numerous reports of complications . . . including bacterial infection, granulomas disfiguring masses of chronically inflamed tissue] and localized necrosis tissue death."

I find this concept very interesting and even tempting, but, how or why do these complications happen? Are there any actual documented cases of these complications? And if so, how many of these people have been affected?

Thanks in advance for answering my questions.

Dr. Michael Olding: Good question... If I was contemplating this surgery... or any for that matter, I would want to know if there were complications and what they were and how often they might occur. The answer to that question is usually based on volumes of scientific articles or in the case of drugs and medical devices, the FDA reviews the material of the company wishing to get FDA approval, who looks at all of the info and makes a decision about the safety and efficacy and complications. Lipodissolve works by killing the fat or whatever it encounters.


Arlington, Va.: How does lipo dissolve work? Does it work?

Dr. Michael Olding: People, even the advocates are not certain how it works, except that it kills the cells... Does it work?? Well, it might, but in VERY limited areas. Trouble is we dont have good double-blinded, placebo-controlled studies. Most of the reported results are anecdotal .


Los Angeles: I have heard the lipo-dissolve is banned in Brazil...Why is it allowed here if not proven safe?

Dr. Michael Olding: Brazil apparently banned one of the substances used in lipodissolve because so many non-medical professionals were using it and the complication rates were high....


Worcester, Mass.: While I understand the need for quality control of the solutions as well as a study to prove its effectiveness, I am concerned that the doctors are opposing this treatment on an economic basis. Please comment.

Dr. Michael Olding: I know that people have been saying that, but it makes little sense to me since it is unregulated. If I thought it was safe and effective I would be using it. It will never be a substitute for liposuction because it can be done only in small areas. It is an ethical question, not a financial one.


Washington, D.C.: It is my understanding that lipo-dissolve has not been approved by the FDA. How long should this take? The ingredients were described in an earlier Washington Post article as being natural, exactly what are the ingredients, as well as what are the possible side effects? How much down time can be expected, as well as how many injections might be required for the lipo-dissolve within the abdominal area. If it took 75 injections for a patient's double chin and jowl area, what are the minimum/maximum injections for areas larger than the chin and jowl?

Dr. Michael Olding: The two substances commonly used in injections to "dissolve" fat are phosphatidylcholine (PPC) and Sodium Deoxycholate. You're right it is reported to take multiple sessions and many injections.


Leesburg, Va.: I've seen a lot of before and after pictures online and they show pretty dramatic results. Should I believe these types of results?

Dr. Michael Olding: Pre and Post op photos are very important for deciding if you want a procedure, but be cautious... lighting , positioning angle of the photo, and particularly in the case of liposuction or lipodissolve, patients often loose weight after the procedure because they are motivated to do so and some of the result may be due to the weight loss alone...


Rockville, Md.: What's the difference between mesotherapy and lipo-dissolve?

Dr. Michael Olding: Great question... "Mesotherapy" is a more general term for a variety of minnimally invasive techniques in which different medications are directly injected into the skin and the layer beneath the skin for many reasons including musculoskeletal problems, neurological problems and cosmetic conditions. "Lipodissolve" or Lipotherapy (or several other terms), refers specifically to the treatment of fat deposits thru injections.


Gaithersburg, Md.: Are there any programs for having the procedure and becoming an "ad" for this procedure or participate in a study to receive this procedure or any programs for surgery on double chins? I simply cannot afford a procedure not covered by insurance.

Dr. Michael Olding: Contact the American Society for Aesthetic Plastic Surgery to see if there are any such studies in your area. Good luck.


Sachse, Texas: I have had lipo-dissolve. Is there anyway to reduce the size of the nodules you receive after treatment.

Dr. Michael Olding: How long ago did you have the injections? Nodules are a common problem... some will go away with time. I usually do not recommend reoperating on any problem for 8-12 months unless absolutely necessary because the scar tissue that forms can "soften" during that time. Most importantly, I would speak with your doctor and ask him/her first.


Indianapolis, Ind.: Does lipodissolve EFFECTIVELY reduce fat stores?

Does the treatment method reduce the size of fat cells or irradicate them completely?

Dr. Michael Olding: It kills fat cells, it doesn't decrease the size of them. My problem with the technique is that its safety and effectiveness has not been investigated thoroughly enough.


Daviston, Ala.: How can shots that dissolve fat not damage other tissue and cause necrosis?

Dr. Michael Olding: Exactly...they can. If injected into the skin, it can kill the skin, thus one of the potential complications. What is injected is a liquid and therefore it is important that it be injected only in the fat layer. I believe that precise placement of the "cocktail" that is injected is undoubtedly difficult.


Atlanta, Ga.: Are there any long term studies on the effects of the procedure that document how long it lasts, the effect on internal organs, adverse events, etc.?

Dr. Michael Olding: Well, there are some studies, but not enough in my opinion and not good "double-blinded" studies -- ones where the person injecting and getting injected do not know if the injected substance is a placebo (i.e., something like water that we know will not affect the fat) or the lipodissolve cocktail. Then, once adequate time has elapsed, a doctor who again doesn't know which patients have had the placebo and which have had the cocktail evaluate the patients to see if there is any difference between the two groups. It is the BEST way to evaluate the effects.


Thousand Oaks, Calif.: Neither phosphatidylcholine or sodium deoxycholate has been approved as an active ingredient in any FDA approved drug. How does the FDA allow this drug to be manufactured and distributed?

Dr. Michael Olding: I cannot speak for the FDA, but the FDA is more of a licensing body rather than an enforcing body. The cocktails that are injected are "compounded" which means they mix the substances at their pharmacies. I know that this is an area of interest to the FDA.


Martinsburg, W.V.: How is the effectiveness of new procedures like these determined? I know there is testing and studies, but at what cost to the public?

Dr. Michael Olding: My point exactly. What is safe and effective so far as the FDA is concerned (and this is not FDA approved) is determined by a rigorous set of steps set forth by the FDA. Many studies are performed before something is FDA approved, usually including histologic,chemical, perhaps animal studies and then clinical trials that are carefully controlled and monitored. Once the company brings it to the FDA, a special advisory board appointed by the FDA (which often consists of experts in the field and other scientists) hear the information as well as public opinion (if there is any) and then that advisory board makes a recommendation to the FDA and they decide whether or not to approve it.


Kensington, Md.: It seems crazy (and scary) that companies can perform a procedure like this without FDA approval. I have heard a lot of these commercials and I just assumed it was approved!

Dr. Michael Olding: Wrong. It is not approved by the FDA


Judiciary Square: Since you aren't a proponent for Lipodissolve, what type of procedure would you suggest for a female who has some stubborn belly fat, combo of baby belly and just fat? One of the major advantages of lipodissolve appears to be the lack of real downtime but don't most other options, cost more and require at least a week if not more of down time? Thanks.

Dr. Michael Olding: Each patient is different, so it is hard to make any recommendations for you online. Plastic surgeons take into consideration not only the amount of fat, but also the amount of excess skin and the skin elasticity before making a recommendation. For example, if you have had a number of children and the skin and perhaps even the abdominal wall have been permanently stretched out, you are probably not a candidate for liposuction alone. In that case, you would have a poor result if you had liposuction alone since it would just deflate the area beneath the skin and cause it to sag more. In that case you would need a tummy tuck or mini-tummy tuck.

The amount of lipodissolve fluid that can be injected

at one time is limited because of the systemic(ie the effects on the entire body) side effects of too much given at one time. Therefore you have to go back more than once and it is my understanding that there are charges for each time. It may not be more cost effective in the long run.


Washington, D.C.: Thanks for taking my question. Can you explain how the safety of this procedure has been demonstrated? I realize the dissolved fat is believed to be excreted, but how has the safety of the PCDC injections been established? Is the PCDC also eliminated from the body? How is this known? Were studies done on laboratory animals? This may not be easy to explain in a paragraph, but any insight you have would be appreciated.

Dr. Michael Olding: These are all very insightful, and appropriate questions. I do not feel that it represents standard medical practice at this time. I am conservative by nature, and I believe in offering a technique that we know is safe and effective -- and liposuction (both standard and ultrasonic) has proven to be safe and effective. However, no procedure is 100 percent safe. You need to optimize your chances as much as possible. Do this by contacting the American Society of Plastic Surgeons or the American Academy of Dermatology or the American Society for Aesthetic Plastic Surgery for information and names of qualified, Board Certified physicians.


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