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The Use of Phosphatidylcholine for Correction of Lower Lid Bulging Due to Prominent Fat Pads
Abstract
Patients with prominent periorbital fat pads often complain of having a persistent "tired" look and seek treatment from their dermatologist.
A non-surgical treatment of fat pads.
Thirty patients were treated for prominent lower eyelid fat pads with phosphatidylcholine injection. Pre- and posttreatment photographs were taken for long-term analysis.
A marked reduction of the lower eyelid fat pads was noted over the 2-year follow-up period. There were no recurrences.
The injection of phosphatidylcholine (250 mg/5 ml) into the fat pads is a simple office procedure that may postpone or even substitute for lower eyelid blepharoplasty.
... The studies published at the beginning of the new millennium [11][12][13][14] show the actual effectiveness for reducing unwanted fat, first in the lower eyelid, and then all other parts of the body. ...
... Clinical evidence and scientific studies have proven the effectiveness of adipocytolytic substances for the nonsurgical reduction of antiaesthetic subcutaneous fat. 1,[5][6][7][8][11][12][13][14][15][16][17][18][19]21,22,28 The products on the market that have obtained approval from competent bodies (CE and Food and Drug Administration) do not contain FC and have been proven to be more efficient with respect to first-generation products. 1,2,20,38,39 However, all of them having a nonenzymatic mechanism of action, based only on a deterging effect, the selectivity is mainly determined by the position in which the substance is released. ...
Background
Reconstruction intralipotherapy is a term commonly used in the field of aesthetic medicine, above all in Europe, which defines a specific injection technique developed for the treatment of localized fat with substances that provoke the lysis of adipocytes by means of an injection directly into the adipose tissue with a long needle. The aim of this study is to define the technique in detail and everything that is associated with it, on the basis of years of multicenter experience by doctors who perform it.
Materials and Methods
From January 2010 to December 2014, 3,080 European physicians were trained in intralipotherapy technique, and approximately 152,500 patients were treated. The adipocytolytic agent used is a Conformité Européene-certified device. The technique, equipment, protocol, posology, postoperative management, and adverse events are described below.
Results
The intralipotherapy technique combined with the appropriate adipocytolytic agent has been shown to be effective in every zone on the average of 76.7% of the cases. The variability is due to the area treated and the patient. The standardization of the technique, homogeneity of the protocol, and the posttreatment management have been essential for standardizing the results and minimizing any adverse events. The latter occurred only in a small percentage of the cases, while those more serious have been extremely rare.
Conclusion
This study shows how the intralipotherapic technique, when performed properly with an appropriate adipocytolytic device and when proper precautions are taken, can be effective and safe for reducing undesirable subcutaneous fat deposits.
... As phosphatidylcholine is a very viscous lipid, it requires a detergent to solubilize it sufficiently for use as an injectable preparation. Deoxycholate is often used for this purpose and was included in the commercially available solution used by Dr Rittes (22). ...
... Early experiments treating infra-orbital fat with 50 mg mL -1 phosphatidylcholine relied upon subjective measures of success (22,24). Later studies emphasized the weakness of relying on patient reported outcomes and the importance of using blinded observers to evaluate success (25). ...
Mesotherapy, which is the injection of substances locally into mesodermally derived subcutaneous tissue, developed from empirical observations of a French physician in the 1950s. Although popular in Europe for many medical purposes, it is used for local cosmetic fat reduction in the United States. This paper reviews manuscripts indexed in PubMed/MEDLINE under 'mesotherapy', which pertains to local fat reduction. The history of lipolytic mesotherapy, the physiology of body fat distribution, the mechanism of action of different lipolytic stimulators and their increased efficacy in combination are reviewed. Mesotherapy falls into two categories. Lipolytic mesotherapy using lipolytic stimulators requires more frequent treatments as the fat cells are not destroyed and can refill over time. Ablative mesotherapy destroys fat cells with a detergent, causes inflammation and scarring from the fat necrosis, but requires fewer treatments. The historic and empiric mixing of sodium channel blocking local anaesthetics in mesotherapy solutions inhibits the intended lipolysis. Major mesotherapy safety concerns include injection site infections from poor sterile technique. Cosmetic mesotherapy directs the area from which fat is lost to improve self-image. Studies were of relatively small number, many with limited sample sizes. Future research should be directed towards achieving a Food and Drug Administration indication rather than continuing expansion of off-label use.
... At the beginning of the 21 st century, several studies with Statistica 13.3. In the first stage, the distribution of variables was verified and, once it was considered normal, the t-test for dependent groups was used to compare (6)(7)(8) . It was wrongly believed at that time that PC is responsible for cellular lysis. ...
Introduction:
Many women consider local fat deposits unacceptable for aesthetic reasons as they have negative impact on appearance and thus, contribute to reduced self-esteem. Injection lipolysis (intralipotherapy) may be an alternative for conventional liposuction in reducing fat deposits.
Aim:
The aim of this paper was to assess the efficacy of high-frequency ultrasound-guided injection of deoxycholic acid (intralipotherapy) to remove fat deposits on the inner side of knees.
Materials and methods:
The procedure was performed in 7 women (14 inner sides of knees). The formulation was administered under high-frequency ultrasound guidance. The procedure was performed twice at 4-week intervals in each patient. High-frequency ultrasound guidance was used to monitor such parameters as the thickness of the dermis (DermaMed, Dramiński S.A.) or the subcutaneous tissue (Philips Epiq 5, USA). Ultrasound was performed both before and after treatment. Additionally, anthropometric measurements were taken, a questionnaire was performed, and a photographic documentation was recorded.
Results:
Reduction in knee circumference and subcutaneous tissue occurred in 71.42% of patients.
Conclusions:
Intralipolysis with deoxycholic acid formulation is an effective method for reducing fat deposits on the inner part of the knees. Ultrasonography proved to be a useful method to monitor the procedure (correct administration of the preparation) and to assess treatment outcomes. A small sample size was a limitation of our study; therefore further studies are needed.
... [5] Maggiori [6] used PC for infiltration into xanthelasmas and a Brazilian dermatologist self-experimented local injections of PC for lower eye bags. [7] However, due to safety concerns the usage in periocular areas is no longer recommended. Further studies on the subject started in Europe in 2001, and "Network Lipolysis" was founded in Germany in 2003 to extensively study the scientific basis of injection lipolysis. ...
Background
Phosphatidylcholine and deoxycholate (PC–DC) injections have been used as nonsurgical alternatives to liposuction. DC as a constituent for lipolysis has recently been approved by the US Food and Drug Administration.
Aim
PC and DC have independently been used in lipolysis. We hereby present a systematic review of literature on injection lipolysis and share our experience of using DC in combination with PC for injection lipolysis. We have retrospectively evaluated the effects of PC–DC treatments in varied age groups, both sexes, and over different target areas.
Materials and Methods
This study spans over 14 years wherein 1269 patients of different age groups and sex were treated with injection lipolysis with PC–DC combination. The PC–DC cocktail injection was given to all patients for an average four sessions every 4 weeks, and the results were assessed after 8 weeks from the last session.
Results
The effects were best appreciated over the face (malar, jawline, and submental areas) and upper arm, whereas average effect was observed on the thighs and around the knees. We have also used lipolysis as a primary modality as well as a touch-up modality following liposuction. The results are better appreciated in primary lipolysis. The need for follow-up sessions (1–2 sessions) of lipolysis and the quantification of results in subsequent sessions reveal that maximal improvement is achieved in the first session.
Conclusion
PC–DC cocktail used for lipolysis as a local administration is effective for reducing unwanted fat. It shows great efficacy in treating localized fat, especially over the face and bra roll in the women of younger age group (20–30 years).
... O primeiro trabalho utilizando injeções localizadas de compostos lipolíticos para diminuição de depósitos de gordura foi publicado por uma brasileira, em 2001. O trabalho descreve a injeção de Lipostabil® (Aventis Pharma, Alemanha), composto de fosfatidilcolina (FC) e desoxicolato de sódio (DC), em acúmulos de gordura na pálpebra inferior de 30 pacientes [1]. Todos apresentaram diminuição da gordura no local, avaliado por fotografia, e o efeito se manteve visível por até 2 anos. ...
Desde a primeira publicação a respeito, em 2001, injeções lipolíticas para gordura localizada tornou-se um procedimento amplamente utilizado na clínica. Consiste de múltiplas injeções subcutâneas de compostos lipolíticos, que podem ter diversos mecanismos de ação. O fármaco mais utilizado atualmente, o desoxicolato de sódio, foi descoberto por acaso, em uma associação com fosfatidilcolina em que sua única função era de veículo da fórmula. Conforme estudos foram sendo realizados, concluiu-se que a ação no tecido era devido ao desoxicolato, um sal biliar que emulsiona os lipídios da membrana celular, resultando em lise do adipócito e consequente necrose do tecido adiposo. Seus principais efeitos adversos, muito frequentemente relatados, incluem dor intensa, edema e formação de nódulos fibrosos nos pontos aplicados. Em decorrência de falhas na aplicação, alguns efeitos adversos mais graves podem ocorrer, como injúria do nervo facial e infecções persistentes. Apesar destes, a utilização de desoxicolato de sódio na camada subcutânea apresenta resultados muito positivos, como publicado em diversos ensaios clínicos, inclusive com relação à satisfação do paciente perante o desfecho final, sendo, portanto, uma boa escolha de técnica para contorno corporal e diminuição de depósitos de gordura localizados. Palavras-chave: injeções lipolíticas, gordura localizada, desoxicolato de sódio, fosfatidilcolina.
... 7 Mesotherapy is promoted as a 'non-surgical alternative to liposuction' as the most significant indication are reduction of adipose tissue including cellulite, lipomas and weight loss. [9][10][11] Mesotherapy is based on the principle of Local Intradermal Therapy (LIT) where a 'micro deposit' of the drug in the dermis which then is slowly released into the surrounding tissues. LIT allows effective concentration of the drug to reach the target area though it only permits lower doses to be administered compared with p.o./i.m. routes. ...
Mesotherapy is a medical specialty that involves the introduction of various therapeutic agents like natural extracts,
homeopathic agents, pharmaceuticals and vitamins in microscopic quantity to the skin. Mesotherapy has various
therapeutic applications. Factors that provide wider reception of mesotherapy includes affordable armantarium,
comparatively less training for the providers, limited dose of drugs with resultant minimum chances of untoward
effects, minimally invasive/painful outpatient procedure with early positive results.
This article highlights the possible mechanism of action, indications, contraindications and therapeutic applications
of mesotherapy.
... Various injection sites were tried in these pilot studies, including lower lid fat pad herniation, large volume injection of "cellulite" in the gluteotrocanteric region, "back rolls," and lipomas. 9,17,[21][22][23][24] aTX-101 showed promising results in the first FDa-approved clinical trials of an sDc-based solution. The results of a multicenter study of 363 patients who expressed dissatisfaction with their submental area was reported in 2014. ...
Noninvasive procedures targeting the elimination of unwanted adipose tissues have recently been developed. injection adipolysis is the term for the injection of cytotoxic substances into these tissues, with the intent of cosmetic improvement by volume reduction. initial attempts in the field utilized intravenous preparations of sodium deoxycholate and soy-derived phosphatidylcholine, approved for the intravenous treatment of fat emboli and dyslipidemias in countries outside the United States. it was initially purported that the active ingredient in these injections was phosphatidylcholine. Subsequent research discovered that injections of sodium deoxycholate alone were capable of inducing cellular lysis in vitro. These compounds also demonstrated an affinity for adipose tissue, sparing the overlying dermis and epidermis. The United States Food and Drug administration (FDa) recently approved a formulation of sodium deoxycholate 10mg/mL for subcutaneous injection with the indication of aesthetic improvement of excess submental fat. it has shown moderate eFcacy with appropriate patient selection and good patient satisfaction. However, previous research leading to the development of this drug proposed that including phosphatidylcholine to a more appealing cosmetic result, with decreased severity of injection-site reactions. Future drugs in the field of injection adipolysis may attempt to combine these ingredients for improved cosmesis and tolerability.
... Injectable fat-reduction techniques emerged in the world literature in 2001, when Patricia Rittes, a dermatologist in São Paulo, Brazil, reported reduction of infraorbital fat after direct, transcutaneous injection of phosphatidylcholine (PC) combined with sodium deoxycholate (DC) solution. 1 Despite lack of approval by any regulatory body, PC/DC combinations have been used off-label by healthcare practitioners to reduce subcutaneous fat in selected patients. 2,3 In Europe, the only drug with CE marking (approval) for the reduction of localized fat is Aqualyx (Marllor International; San Giovanni in Marignano, Italy). ...
Injectable fat-reduction techniques emerged in the world literature in 2001, when Patricia Rittes, a dermatologist in Sao Paulo, Brazil, reported reduction of infraorbital fat after direct, transcutaneous injection of phosphatidylcholine (PC) combined with sodium deoxycholate (DC) solution.1 Despite lack of approval by any regulatory body, PC/DC combinations have been used off-label by healthcare practitioners to reduce subcutaneous fat in selected patients.2,3
In Europe, the only drug with CE marking (approval) for the reduction of localized fat is Aqualyx (Marllor International; San Giovanni in Marignano, Italy).4 Currently, it is approved in approximately 50 countries. Aqualyx is a DC-based solution with a lactose-based delivery system, formulated to control and enhance the action of external ultrasound waves for the microcavitation of adipose tissue.5 It does not contain PC. Aqualyx was designed for the medical treatment (reduction) of localized adipose tissue5 and is sold exclusively to physicians trained in intralipotherapy, the injection technique for its insertion.6 The product has been in clinical use since 2009 for the nonsurgical reduction of localized adiposity, lipohypertrophy, subcutaneous lipohyperplasia, and “buffalo hump”.6-8
Aqualyx is an aqueous microgelatinous solution comprised of the following: polymer of 3:6-anhydro-L-galactose and D-galactose; buffer systems; 3-alpha-12alpha-dihydroxy-5-beta-24-oico cholanic acid sodium salt; and saline solution.7,8 The solution appears similar in composition to DC, but it is considered a medical device—not a drug. A claim regarding this matter has been submitted to the Italian Ministry of the Health.8
Aqualyx is marketed as a 2-step product: immediately following injection (step 1), it is recommended that external ultrasonography be performed (step 2).5 However, …
... However, they may be appropriate for patients who are unwilling or unable to undergo surgical reduction of small collections of fat, and for patients who desire touchups for liposuction-induced irregularities. 1 Injectable fat-reducing techniques emerged in the world literature in 2001, when Patricia Rittes, a dermatologist in São Paolo, Brazil, reported reduction of infraorbital fat using direct, transcutaneous injection with a phosphatidylcholine (PC)-based product (Lipostabil; Sanofi-Aventis, Paris, France). 2 Lipostabil is marketed for intravenous use in Europe, South America, and South Africa as a treatment for numerous fat-related disorders, including hyperlipidemia, angina pectoris, and diabetic angiopathy. Lipostabil consists of soy-derived PC (5%), its solvent (sodium deoxycholate [DC]; 2.5%), dl-a-tocopherol (vitamin E), sodium hydroxide, ethanol, and benzyl alcohol, in sterile water. ...
Injectable fat-reducing therapies are not an alternative to liposuction. Rather, they may be best suited for patients who are unwilling or unable to undergo surgical reduction of small collections of fat, and for patients who desire touchups for liposuction-induced irregularities.
The authors report their 4-year experience with a novel injectable CE-marked drug, used in an off-label manner.
Between October 2009 and November 2013, 186 patients were treated by injection of an adipocitolytic solution in 1 of 4 private Italian aesthetic facilities, by 1 of 4 independent physicians. Treated areas included the neck, hips/saddlebags, abdomen/love handles, inner thighs, and buffalo hump. Complications and side effects were documented.
All patients experienced mild to moderate swelling and reddening of the skin, which resolved 3 to 5 days after injection. No major complications or side effects occurred, such as necrosis. Rates of transient events were as follows: hematoma, 1.61%; paresthesia, 1.07%; and ecchymosis, 6.45%. Pruritus was reported by 21.5% of patients, which began 3 to 7 days following injection. Subcutaneous nodules were noted in 1.61% and resolved within 4 months of injection. A transitory "unusual sensation" was reported by 12.9% of patients, which lasted up to 2 months after final injection.
Results demonstrate that this CE-marked agent appears to be effective and safe for medical treatment of fat reduction.
4 Therapeutic.
© 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.
... 7 Theorization continued 8 and the local vs systemic effects analysis got most of the attention. 9 The first effectiveness results started to appear, 10 but "off-label" uses, 11 sometimes even reckless, and the use of these products by non-qualified personnel, undermined society's confidence in this kind of procedures. ...
Adipocytolytic therapies have always raised the interest of aesthetic medicine physicians, mainly because of the great potential to achieve spectacular results in localized adiposities reduction. In the last few decades, these results have been severely compromised due to the improper or reckless injection of these products, to the extent of some of them being banned in many countries. Today, there is a new adipocytolytic solution that has been approved, is effective, and has theoretic and empiric consensus regarding its safety. The aim of this study for which 331 therapeutic sessions were retrospectively analyzed is to provide evidence of its safety and efficacy.
J Drugs Dermatol . 2014;13(12):1451-1455.
... Nonsurgical techniques for localized fat reduction comprise nonsurgical energy devices such as external laser, radiofrequency, cryolipolysis, and ultrasound [5][6][7], and injectable fat-reducing formulations [8]. The latter have been investigated for the reduction of subcutaneous fat in small studies [9][10][11][12][13][14][15][16], but no injectable pharmacologic treatment is currently licensed for the reduction of SMF. Overall, robust clinical evidence regarding the efficacy and safety of nonsurgical methods for the reduction of SMF is lacking. ...
Background
The injectable adipocytolytic drug ATX-101 is the first nonsurgical treatment for the reduction of submental fat (SMF) to undergo comprehensive clinical evaluation. This study aimed to confirm the efficacy and safety of ATX-101 for SMF reduction through a post hoc pooled analysis of two large phase 3 studies.
Methods
Patients with unwanted SMF were randomized to receive 1 or 2 mg/cm2 of ATX-101 or a placebo injected into their SMF during a maximum of four treatment sessions spaced approximately 28 days apart, with a 12-week follow-up period. The proportions of patients with reductions in SMF of one point or more on the Clinician-Reported SMF Rating Scale (CR-SMFRS) and the proportions of patients satisfied with the appearance of their face and chin [Subject Self-Rating Scale (SSRS) score ≥4] were reported overall and in subgroups. Other efficacy measures included improvements in the Patient-Reported SMF Rating Scale (PR-SMFRS), calliper measurements of SMF thickness, and assessment of skin laxity [Skin Laxity Rating Scale (SLRS)]. Adverse events and laboratory test results were recorded.
Results
Significantly greater proportions of the patients had improvements in clinician-reported measures (≥1-point improvement in CR-SMFRS: 58.8 and 63.8 % of the patients who received ATX-101 1 and 2 mg/cm2, respectively, and 28.6 % of the placebo recipients; p
... PC is an endogenous phospholipid that can be injected intravenously for the treatment of posttraumatic intra-arterial fat emboli. 2 Based on the assumption that PC could solubilize triglycerides within living adipocytes in the same way it solubilizes intravascular fat emboli, clinicians began injecting cosmetically undesirable subcutaneous fat tissue with PC-containing solutions developed for intravenous use. 1, 3 Rittes first reported improvements in the appearance of lower eyelid fat pads after injecting a PC-containing solution directly into these fat pads in 30 patients. 4 After this initial report, several subsequent publications reported that PC injections produced aesthetic improvements by reducing subcutaneous fat. 5 These studies described variations of a technique in which a PC-containing solution was periodically injected directly into subcutaneous fat pads over several months. 3,6-8 These treatments were reported to remove subcutaneous fat (as inferred from clinical photographic images) and to induce fat cell necrosis (as observed in histological sections harvested from injection sites), 9 although no injectable formulation has received approval from any regulatory agency for cosmetic fat reduction. ...
Background:
Recent studies suggest that the principal active ingredient in phosphatidylcholine-containing injectable fat-reduction formulations is actually deoxycholate (DC). This bile acid acts as a detergent to rapidly disrupt cell membranes. Thus, it is not obvious why DC would preferentially target fat.
Objective:
To investigate possible mechanisms for the selectivity of DC for fat tissue using in vivo and in vitro models.
Methods and materials:
Histology, drug distribution studies, and cell viability assays were used to examine possible mechanisms contributing to DC selectivity.
Results:
In vitro, DC caused the lysis of all cell types tested within the tested concentration range. DC injected into fat tissue caused adipocyte death, whereas other cell types appeared less affected. Physiological concentrations of albumin or protein-rich tissues decrease the ability of DC to lyse cells. Furthermore, DC relocated to the gastrointestinal tract in animals within hours of injection. This suggests that similar mechanisms may be present in humans.
Conclusion:
We report observations that provide a possible explanation for the in vivo preferential fat targeting by DC. Fat tissue, being deficient in cell-associated proteins and interstitial albumin, may be unable to sufficiently neutralize the detergent activity of DC, possibly making fat uniquely sensitive to DC.
... Data concerning the outcome and the safety of its use have not yet been established. Further basic science and clinical trials should precede the use of this drug for aesthetic application [54][55][56][57][58][59][60][61]. ...
Aqualyx (Marllor International Ltd, Rimini, Italy) was originally developed in Italy by Professor Pasquale Motolese and has been commercially available since 2009. It is a deoxycholate, aqueous gelatinous solution mixed with saline and buffering compounds. It is the only drug approved by the European Union for the reduction in localized fat. Aqualyx is sold exclusively to doctors and nurses trained in intralipotherapy. In the case of our patient, the product administered was advertised as Aqualyx, but was not administered by a trained health professional and was administered too superficially. The patient developed severe pain following the injection and was unable to sit for several weeks. There was localized skin necrosis, and palpable collections where the injection was administered. Our initial suspicion was development of an abscess or hematoma. To characterize further, we arranged an ultrasound scan that showed a “superficial hypoechoic lesion” but no deeper infection or spread. The numerous painful nodules ruptured onto the skin surface, resulting in purulent and bleeding lesions. This case demonstrates the importance of appropriate training and competence in performing cosmetic procedures including injections and fat dissolving treatments.
Background:
Beyond submental fat reduction, injectable deoxycholic acid (DCA) has gained popularity in recent years for various minimally invasive lipolysis applications.
Objective:
To summarize and evaluate the evidence of off-label uses of injectable DCA.
Methods:
MEDLINE, Embase, CINAHL, Web of Science, and CENTRAL were searched. The outcomes measured included applications of DCA, treatment regimen, and its efficacy. An overall success rate for each condition was calculated based on the improvement defined in the included studies.
Results:
Eleven studies evaluated the cosmetic use of DCA for excess adipose tissue on various anatomical locations. The outcomes were evaluated at time points ranging from 1 to 21 months post-treatment, with overall success rates over 85%. Eight case reports and series reported the success of using DCA treating lipomas, xanthelasmas, paradoxical adipose hyperplasia, fibrofatty residue of infantile hemangioma, piezogenic pedal papules, and HIV-associated lipohypertrophy. Although the preliminary efficacies were high, the overall recommendations for off-label uses are weak because of the lack of high-level studies.
Conclusion:
The review emphasizes the diversity of injectable DCA as a minimally invasive technique for lipolysis. Further high-level studies demonstrating consistent treatment regimens and methods of evaluation are warranted to make more definitive recommendations regarding off-label DCA use.
Background:
Lipomas are benign adipocytic tumours. Surgical excision is the gold standard for treating such lipomas, but it results in unaesthetic scarring.
Methods:
A total of 126 patients were randomised into two groups. The patients in Group A underwent mesotherapy (n = 66) and those in Group B underwent surgery (n = 60). The patients in Group A group received six sessions of mesotherapy treatment at 2-week intervals. Both groups were followed up for 12 weeks, during which they were assessed for complications arising from treatment, reduction of the size of the lipoma and cosmetic outcomes.
Results:
The overall mean age of the patients was 32.93 (± 10.1) years old and the mean volume of the lipomas was 2.29 (± 3.8) mL. A 55.86% (P = 0.0032) mean reduction in the volume of lipomas was noted in the patients who received mesotherapy, while one patient showed a gain of 16% by volume. The patients in Group A (cosmetic score ≥ 4: 63%) were happier with the treatment than those in Group B (cosmetic score ≥ 4: 21%).
Conclusion:
Our findings indicate that mesotherapy modestly reduces the volume of lipomas with very few and minor complications and excellent cosmetic outcomes.
Purpose:
Deoxycholic acid (DCA) 1% is an injectable detergent indicated for submental fat reduction, although clinically it is being injected off-label for orbital fat prolapse. It is known to cause severe inflammation, local nerve dysfunction, and tissue necrosis, all of which could be catastrophic in the orbit and periocular region. This study evaluated the effects of periocular DCA on orbital and ocular adnexal tissues in a murine model.
Methods:
Mice were treated via split-face intraorbital injections, subcutaneous injections, and topical cornea application with DCA versus phosphate-buffered saline. Whole heads were fixed, decalcified, and sectioned for orbital histology after 1-7 days. Matched pairs of human globes and mouse globes were immersed in either phosphate-buffered saline or 1% DCA for 72 hours.
Results:
Six of 11 mice receiving intraorbital DCA injections died within minutes. Surviving mice developed severe orbital inflammatory necrosis. All orbits injected with phosphate-buffered saline were clinically and histologically normal. Six mice were treated with lower concentrations of DCA and all developed variable amounts of orbital inflammation, hemorrhage, and globe necrosis. Mice receiving subcutaneous DCA injection to the lower eyelid showed inflammatory necrosis, edema, and lid malposition. Topical application of DCA to mouse corneas caused no external or histologic changes. Human and mouse globes immersed ex vivo in DCA developed corneal edema and cataract formation without observable scleral changes.
Conclusion:
Intraorbital and periocular injection of DCA can cause devastating complications in a murine model, and significant caution is advised for off-label use in the periocular region.
Purpose
The purpose of this study is to evaluate the efficacy and safety of treating lower eyelid fat bulging with ultrasound‐assisted lipolysis (UAL) by performing a preclinical evaluation of the procedure on a Yorkshire pig.
Methods
Two white Yorkshire pigs had lower eyelid fat bulging treated with UAL using a probe with a diameter of 1.0 mm or less. Fourteen days after treatment, we evaluated the changes in fat thickness from ultrasound, changes in skin contour (volume and height) from the Antera 3D™, and the disruption of fat cells and changes in collagen synthesis from histological evaluation.
Results
Fourteen days after treatment, the fat layer was significantly reduced with no damage to the skin surface. The mean change in the subcutaneous fat layer thickness was decreased 1.51‐0.75 mm in ultrasound analysis. The skin contour of the treated area also decreased with time from 202.5 to 163.5 mm in mean volume and 0.8111 to 0.646 mm in mean height. Masson's trichrome staining showed that the UAL treatment induced the regeneration and remodeling of collagen.
Conclusion
The results of this study demonstrate that UAL successfully reduced the bulging lower eyelid fat of a Yorkshire pig and also increased collagen contraction to tighten skin. UAL may be a beneficial and well‐tolerated treatment option for lower eyelid fat bulging.
The importance of minimally invasive procedures to reduce fat compartments in the face and body has steadily increased over the last 15–20 years. With the introduction of fat-reducing injectables, called chemical lipodestruction or lipodissolve, into the toolbox of aesthetic physicians, a new field of activity has been opened up, which is accepted by many patients because it is a non-surgical procedure. Recently, work has been done to combine chemical lipodestruction with other methods in order to be able to reduce larger volumes. Initial studies on the combination of several fat-reducing methods have shown good results, in particular for body contouring of larger fat compartments.
Baggy, puffy eyelids are viewed by most people as a sign of exhaustion and aging. Many individuals will go to great lengths to improve the appearance of their periorbital skin using cosmetics, fillers, botulinum toxin, chemical peels, dermabrasion, lasers, and surgical procedures.
Sabe-se que um dos processos mais utilizados para o tratamento de pequenos e moderados depósitos de gordura é a lipoaspiração. Porém esse método cirúrgico além de oneroso apresenta alto risco. Em anos recentes, outro procedimento, a aplicação tópica de fosfatidilcolina, vem sendo empregado com o mesmo propósito. Embora a forma injetável de fosfatidilcolina não tenha sido aprovada para fins cosméticos no Brasil, o medicamento tem sido amplamente utilizado. Recentemente, seu uso cosmético espalhou-se além das clinicas médicas, chegando até as academias e salões de beleza. Isso evidencia a urgência da realização de pesquisas visando ampliar os conhecimentos sobre os efeitos da aplicação da fosfatidilcolina com objetivos cosméticos. Assim sendo, na presente revisão serão abordados alguns aspectos referentes ao exercício e à ação da fosfatidilcolina no controle da adiposidade, bem como seu emprego no tratamento da gordura localizada bem como alguns efeitos colaterais. São, também, apresentados dados referentes a estudos em modelos animais.Palavras-chave: exercício, fosfatidilcolina, depósitos de gordura, adiposidade.
Intralipoterapi adalah injeksi subkutan larutan adipositolitik untuk mengurangi akumulasi lemak subkutan lokalisata. Bahan utama larutan adipositolitik ini adalah asam empedu sekunder deoksikolat (DK). Asam empedu ini dapat menyebabkan adipositolisis dengan melarutkan fosfolipid membran dan membentuk micelles. Membran yang lisis akan mengeluarkan trigliserida intraadiposit untuk dipecah menjadi gliserol dan asam lemak bebas oleh enzim lipase. Pengamatan histologik spesimen jaringan subkutan yang diinjeksi dengan larutan DK menunjukkan adanya inflamasi akut, infiltrasi limfomononuklear, nekrosis lemak, dan makrofag lipid-laden. Enam bulan setelah injeksi pertama, temuan histologik menunjukkan fibroblas dan fibrosis lebih dominan. Hal ini mendukung hipotesis bahwa adiposit yang lisis akan disubstitusi oleh jaringan fibrotik. Konsentrasi DK yang tinggi dapat menyebabkan komplikasi berupa nekrosis dan ulserasi. Intralipoterapi menggunakan DK konsentrasi rendah merupakan pilihan terapi yang relatif aman dan efektif untuk akumulasi lemak lokalisata yang tidak diinginkan. Kata kunci: Intralipoterapi, lipolisis, asam empedu, deoksikolat, adiposit, akumulasi lemak lokalisata
Background
Cryolipolysis combined with shockwave therapy has been previously shown to have synergistic effects in body contouring results.
Objective
This open‐label, prospective, multicenter, comparative study investigated the safety and efficacy of combined cryolipolysis, shockwave therapy with cryolipolysis, shockwave therapy, and injection polyenylphosphatidylcholine‐based lipolysis.
Methods
Enrolled patients were treated in the abdominal or flank area with cryolipolysis, shockwave therapy and injection lipolysis (n = 10) or cryolipolysis and shockwave therapy (n = 4). All treatments were conducted the same day. Evaluations were conducted 3 months after treatment and included histological analysis, standardized photography, blinded‐investigator efficacy, and safety ratings, as well as patient ratings of satisfaction and tolerance.
Results
Compared to baseline, the 3‐month follow‐up histological analysis revealed a more profound subcutaneous adipose tissue reaction with the triple combination therapy (cryolipolysis, injection lipolysis, radial shock wave) than with the double combination with regard to adipocyte damage and grade of inflammation. Waist circumference was significantly reduced in patients of both groups, but patients in the triple combination group were shown to have a significantly more pronounced reduction in subcutaneous fat. Factors that were shown to influence treatment outcome included baseline BMI and waist circumference. Age and gender had no effect. The abdominal area reacted better to the treatment compared to flanks. No significant side effects or adverse events were reported. The procedure was well‐tolerated, and the majority of patients were satisfied with the treatment results.
Conclusions
Combination of cryolipolysis, radial shockwave, and injection lipolysis is a safe, well‐tolerated treatment for reduction in subcutaneous fat.
Background
Lipomas are very common benign neoplasms, which constitute 99% of all adipose‐derived tumors. Main treatment option includes surgical excision, which is unacceptable for a number of patients seeking ways to improve esthetic appearance of their skin. Therefore, alternative treatment options are being sought.
Objective
The aim of the present study was to assess the efficacy of lipoma removal using a Class III CE‐marked device (Aqualyx™) administered as a high‐frequency ultrasound‐guided injection (intralipotherapy).
Methods
A total of 17 lipomas were treated. The procedure involved a high‐frequency ultrasound‐guided injection. A maximum of 3 injections per a lipoma were performed. High‐frequency ultrasound was used for assessing the size of lipomas and monitoring treatment‐induced changes to the lipomas and adjacent tissue.
Results
Response to treatment was achieved in all cases. A complete removal was achieved in 70.59% of lipomas. The remaining 29.41% of lipomas were not completely removed, yet significantly reduced in size.
Conclusion
An injection of Aqualyx™, a CE‐marked drug, is a good noninvasive treatment of lipomas. Ultrasound guided procedure is recommended, as it ensures appropriate technique and enables monitoring treatment‐induced changes. Considering a low number of published reports of such treatment, it is crucial to continue this research.
Background
The use of deoxycholic acid to reduce localized fat deposits is a procedure that has been in use for about 30 years. Its effectiveness as treatment is due to emulsification of phospholipids and therefore, solubilization of the biological membranes with resulting fat necrosis. The purpose of the study was to assess the effectiveness and the safety of an injectable solution containing sodium deoxycholtate 1.25% (DB125), used as intralipotherapy.
Methods
The effectiveness and safety of DB125 solution have been assessed with a multicentre observational prospective study carried out between February and October 2017. The 221 selected patients presented with various forms and degrees of localized fat in several areas. Intralipotherapy treatments were performed 6 weeks apart and until the clinical result was obtained. Aesthetic outcomes were evaluated by the authors using preoperative and postoperative photographic documentation and by the patients with their level of satisfaction by filling out an anonymous form. Major adverse events were reported by each doctor who performed the treatment.
Results
Two hundred twenty-one patients treated in 273 cases of different localized fat deposits. One hundred eighty-five patients who could be assessed for final results gave the effectiveness of the treatment an average score of 7.4. The failure percentage of the treatment was 3.8%. The medical evaluation showed treatment success in 93.5% of cases. Adverse events can be divided into 2 groups: minor adverse events, which are very frequent and major ones, which are extremely rare. For both groups, the adverse events can be ascribed to localized problems in the treatment area.
Conclusion
Studies have shown that the second-generation solution containing sodium deoxycholate 1.25% is effective and safe to treat different localized fat deposits. The high degree of effectiveness shown in the study was not associated with a lesser degree of handling because, at the doses indicated and with the use of intralipotherapy, the occurrence of adverse events was minimal.
Introduction
Liposuction and mesotherapy are popular treatments for fat reduction of lower face, but because these treatments are invasive, a novel non‐invasive treatment with similar or better efficacy has been sought. There are various devices such as CoolSculpt, laser, RF, and HIFU that are used as non‐invasive treatments for fat reduction and body contouring, but these applications have not been applied to facial fat reduction. In this study, we selected Monopolar 1‐MHz RF for body contouring to be applied for fat reduction and tightening of the lower face.
Material and Methods
From March through August of 2016, we treated fourteen Asian women (average age: 44.6 years old) for fat reduction and tightening of the lower face using 1‐MHz Monopolar RF (truSculpt™, Cutera, Inc., Brisbane, CA). We performed the treatment primarily in the nasolabial fold and buccal area weekly for five consecutive weeks, and evaluated the effects for fat reduction and tightening before each treatment and for 2 months after the treatment using handy VECTRA 3D® (Canfield Scientific, Inc.) for imaging. Three‐dimensional (3D) volumetric assessments were performed at pre‐ and post‐two‐months after treatment. Patients rated their satisfaction for tightening using a 5‐points scale.
Results
During the study, more than ninety percent of patients showed volumetric change by fat reduction at the treated area, with an average of 2.7 ml. Sixty percent of patients were either “satisfied” or “very satisfied” with the tightening effects. The treatments were accompanied only by very mild heat pain. Efficacy was maintained for 2 months after the treatments, and three patients showed a higher fat reduction effect at 2 months after the final treatment compared with the final treatment. A mild redness was observed just for few hours after the treatment, but complications such as, swelling, induration, burn, sensory disturbance or facial paralysis, were not observed.
Conclusion
In this study, we found that Monopolar 1‐MHz RF applied with a stationary applicator was effective especially for lower face fat reduction and with a tightening effect in facial contouring. A highly efficacious treatment with satisfactory comfort and safety can be achieved with no downtime, and the device has the potential for becoming one of the standard non‐invasive treatments for fat reduction of facial contouring. Lasers Surg. Med.49:750–755, 2017. © 2017 Wiley Periodicals, Inc.
Die Injektions-Lipolyse ist mittlerweile ein anerkanntes Injektionsverfahren zur Reduzierung kleinerer Fettpolster. Über 80 Publikationen in hochwertigen Zeitschriften, mehrere Studien anerkannter Universitäten und Mediziner haben gezeigt, dass eine Zusammensetzung von Phosphatidylcholin (PPC) und Desoxycholsäure (DOC) in der Lage ist, bei einem moderaten Nebenwirkungsprofil kleinere, resistente Fettpolster abzuschmelzen. Durch mikrofeine Injektionen wird ein Entzündungsprozess initiiert, der die Zellmembran der Adipozyten zerstört und das freigesetzte Fett metabolisiert. Insofern ist die gängige Bezeichnung Lipolyse nicht ganz korrekt, besser kann man von Lipodestruktion sprechen.
Body contouring procedures of the trunk and abdomen have historically been among the top five surgical cosmetic procedures performed in the United States [1]. These conventional treatments for body contouring are the gold standard for patients interested in surgically improving or correcting contour abnormalities [2]. These procedures, while effective, are associated with the standard risks of any surgical procedure (e.g., the risks of general anesthesia, infection, wound healing complications) and the prerequisite recovery time. Recently, there has been a trend toward minimally invasive cosmetic procedures. While the total number of cosmetic surgical procedures has gone down over the past 8 years, the number of minimally invasive cosmetic procedures has nearly doubled during that same period of time to over ten million procedures in 2008 [1].
Mesotherapy, microneedling, and chemical peels are minimally invasive techniques used to combat facial aging. Chemical peeling is one of the oldest methods of facial rejuvenation. By using different chemicals in various combinations, strengths, and application techniques, plastic surgeons can tailor a patient's treatment for optimal, safe, and consistent results. Mesotherapy and microneedling have emerged in the plastic surgery literature with increasingly complex indications. Both techniques have increased in popularity although research into efficacy and long-term results is lagging. With a thorough understanding of patients and the modalities available, plastic surgeons can use the appropriate minimally invasive technique to provide patients with desired skin changes.
The topic of injection lipolysis remains controversial even 5 years after of becoming a popular treatment for reducing localized fat deposits with injections rather than surgery. The technique was invented by Rittes who had studied mesotherapy with Lecoz in France. A patient, knowing of Rittes skill with injections, requested an injectable fat reduction for her lower lid bags. The patient persisted despite the absence of an injectable technique for localized fat reduction at that time. Rittes researched the pharmaceutical and clinical literature for a solution. She found Bobkova's article describing the endovenous plaque reducing qualities in Lipostabil, a Sanofi Aventis drug containing phosphatidylcholine (PC) made from soy lecithin [1]. Rittes' paper, published in 2001 [2], is often quoted as the origin of the injection lipolysis procedure.
Mesotherapy describes a diverse array of cutaneous injection techniques that utilizes medications and other compounds proposed to have a therapeutic effect on local medical or cosmetic conditions. Injectable lipolysis refers to a treatment using biologically active detergents to cause focal ablation of adipose tissue. The active ingredient used in injectable lipolysis is deoxycholate. Injectable lipolysis may become a relatively safe and efficacious method to treat submental and mandibular fat and jowls. Mesotherapy may have as yet unproved potential to enhance the appearance of facial skin.
Introduction:
Deoxycholic acid (DOCA) is involved in many physiological functions and has been used in various fields of pharmaceutical formulations as a natural active solubilizing and permeation-enhancing agent. Although DOCA has been suggested to be a promoter of colon cancer, it has also been used extensively as a starting material to obtain new derivatives for potential therapeutic applications. Area covered: In this review, we focus on patents and research reports from 2011 to 2014 related to pharmaceutical formulations and therapeutic applications using DOCA and its derivatives as surfactants or absorption enhancers, drug delivery carriers, and anti-cancer agents. Expert opinion: In recent few years, DOCA and its derivatives have been used mostly as pharmaceutical excipients for solubilizing lipophilic compounds to improve their bioavailability. Other studies have expanded its applications to include enhanced drug permeability and have designed more effective drug carriers by conjugation with polymeric materials. Recently, a synthetic DOCA injection, ATX-101, has shown long-term efficacy in the non-surgical treatment of unwanted submental fat and acceptable tolerability in humans. Thus, it may be used for reducing specific localized fat accumulations. Additionally, DOCA has been a starting material for anti-cancer drugs, and some derivatives showed strong inhibitory activities against several carcinoma cells.
1. This chapter reviews the history of injectable treatments for small collections of fat, with an emphasis on clarifying terminology and mechanism of action of several medications in development. Guidelines on injection dosing and technique are excluded given the current, experimental nature of these medications. 2. Lipodissolve® (an injectable combination of phosphatidylcholine and sodium deoxycholate) and mesotherapy employ unregulated, compounded medications that have been associated with significant adverse events. 3. An adipolytic medication based upon purified, non-animal-derived sodium deoxycholate is in FDA registration trials for the reduction of submental fat. 4. A lipolytic medication, a combination of a β-agonist (salmeterol xinafoate) and a steroid (fluticasone propionate), is in FDA registration trials for the reduction of abdominal fat and exophthalmos. 5. There is currently no data to suggest that injectable medications for cellulite are safe or efficacious.
This chapter reviews the history of injectable treatments for small collections of fat, with an emphasis on clarifying terminology and mechanism of action of several medications in development. Subcutaneous injections that reduce adipose tissue have been most frequently referred to as injection lipolysis, phosphatidylcholine/deoxycholate (PC/DC), Lipodissolve, and mesotherapy. Pharmaceutical grade, injectable medications that permanently or non-permanently remove small collections of fat have aptly been referred to as adipolytic therapy and pharmaceutical lipoplasty, respectively. Importing Lipostabil into the United States is illegal, and there are no approved phosphatidylcholine/deoxycholate (PC/DC) or DC medications for which physicians can use “off-label.” The proclivity for DC to solubilize adipose, as well as nonadipose cell is unsettling, and would appear to explain skin ulceration in isolated reports. The only potential treatment entering clinical trials at this point in time is collagenase.
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L'utilisation de la phosphatidylcholine par injections superficielles pour détruire les adipocytes, quoique déjà ancienne, semble connaître un effet de mode récent en Europe qui amène l'auteur à se pencher sur le bien-fondé de cette méthode. Une année d'utilisation et la fréquentation d'utilisateurs expérimentés le confortent dans son impression première : le procédé, a priori sans grand danger, ne saurait remplacer une lipoaspiration traditionnelle mais pourrait être performant dans les indications limites ou décevantes de celle-ci grâce notamment à la rétraction cutanée entraînée par la réaction inflammatoire consécutive à l'adipolyse.
Lipodissolve is a relatively new technique of injection lipolysis. Localized areas of fat are treated with the injection of a combination of phosphatidylcholine and deoxycholate. These agents work in concert to reduce fat deposits. The article reviews the results for patients treated with Lipodissolve and other injection lipolysis treatments by Dr. Patricia Rittes, the authors, and other practitioners and researchers. They conclude that properly performed, single-stage surgery that allows the surgeon to address all anatomic levels is preferable to Lipodissolve, pending the results of current and future studies and randomized controlled trials.
Background: Phosphatidylcholine and deoxycholate (PC-DC) injections are a popular nonsurgical method to eliminate unwanted fat. The safety and efficacy of this approach is uncertain.
Objective: The authors evaluate the effects of PC-DC treatments on body composition, adipocyte function, and mechanisms responsible for fat loss.
Methods: This randomized, open-label study enrolled 13 women with a body mass index (BMI) ≤30 kg/m2 and lower abdominal subcutaneous fat suitable for small-volume liposuction. Patients were randomized by the final digit of their Social Security numbers and received between 2 and 4 PC-DC treatments, spaced 8 weeks apart. One side below the umbilicus was injected with PC-DC. The contralateral, control side received no treatment. Adipose tissue biopsies were performed on the treated side at baseline, 1 week after the first treatment, and 8 weeks after the final treatment. The primary outcome was change in adipose tissue thickness at baseline and 8 weeks after the final treatment.
Results: Seven women completed the study. Treatment with PC-DC significantly reduced the thickness of the anterior subcutaneous abdominal fat (P = .004). Adipose tissue showed rapid increases in crown-like structures, macrophage infiltration, and reduced expression of leptin, hormone-sensitive lipase, adipose tissue triglyceride lipase, and CD36. Plasma C-reactive protein, lipid profile, and plasma glucose concentrations were unchanged.
Conclusions: PC-DC injections can effectively reduce abdominal fat volume and thickness by inducing adipocyte necrosis. These treatments do not appear to increase circulating markers of inflammation or affect glucose and lipid metabolism.
Level of Evidence: 3
In den letzten Jahren hat sich die subkutane Injektion von Phosphatidylcholin-haltigen Lösungen zu einer häufig angewandten Technik für die minimal-invasive Reduktion kleinerer, umschriebener Fettdepots entwickelt. Obwohl diese sog. „Injektionslipolyse“ allgemein als sicher und nebenwirkungsarm gilt, treten unterschiedliche Komplikationen nach entsprechenden Behandlungen auf. Diese reichen von unbefriedigenden Therapieergebnissen über Hämatome oder Infektionen bis hin zu umschriebenen Haut- und Gewebsnekrosen. In diesem Kontext präsentieren wir den Fall einer 28-jährigen Patientin, die sich ca. 18 Tage nach Injektionslipolyse im Bereich beider Oberschenkel und Knie mit großflächigen, scharf begrenzten, erythematösen, teils lividen Plaques im Bereich der Injektionsstellen sowie deutlichem Ödem und starken Schmerzen im Sinne einer toxischen Dermatitis in unserer Klinik vorstellte.
Mesotherapy simply describes a method of drug delivery. It consists of intra- or sub-cutaneous injections of variable mixtures, including multivitamins, lidocaine, calcitonin, tretinion, hyaluronic acid, hyaluronidase, collagenase, minoxidil, phosphatidylcholine and many others. Mesotherapy can be used for many indications, but its main indication of fat dissolution has been primarily used. Other popular uses include facial skin rejuvenation and alopecia. Given the ease of treatment and its quick effect, with little to no downtime, mesotherapy has become extremely popular. As with any new technology, it is crucially important to assess the benefits and safety. Most of the published data regarding mesotherapy consisted of single case reports and small series. None were large, randomized controlled trials. Given that no large population, randomized controlled trials have ever been performed, it is advised that the use of mesotherapy be limited, and practiced with extreme caution.
Background. Patients with prominent periorbital fat pads often complain of having a persistent “tired” look and seek treatment from their dermatologist.Objective. A non-surgical treatment of fat pads.Methods. Thirty patients were treated for prominent lower eyelid fat pads with phosphatidylcholine injection. Pre- and posttreatment photographs were taken for long-term analysis.Results. A marked reduction of the lower eyelid fat pads was noted over the 2-year follow-up period. There were no recurrences.Conclusion. The injection of phosphatidylcholine (250 mg/5 ml) into the fat pads is a simple office procedure that may postpone or even substitute for lower eyelid blepharoplasty.
Seit 2004 wird weltweit zu einer neuen Therapievariante des medizinisch-ästhetischen Spektrums geforscht: der sog. Injektionslipolyse (IL). Fortschritte im Wissen zu Wirksamkeit und den Wirkmechanismus betreffend gab es v. a. in Deutschland, weil hier im internationalen Vergleich die meisten Anwender zu finden sind. Hintergrund ist, dass in Deutschland für die Wirkstoffkombination Phosphatidylcholin und Desoxycholsäure (PPC-DOC) die Zulassung eines Medikamentes für die i.v.-Anwendung zur Behandlung von Fettembolien besteht. Es ist somit leicht verfügbar, trotzdem ist die subkutane Injektion des Medikaments „Lipostabil N®“ als sog. „off-label use“ einzuordnen. Mittlerweile hat sich die Injektionslipolyse für viele zu einem festen Baustein im Arsenal der ästhetischen Medizin entwickelt. Insbesondere der internationale Zusammenschluss der anwendenden Ärzte in dem sog. Netzwerk Lipolyse (weltweit über 2000 Mitglieder) hat die Entwicklung international gültiger Therapiestandards und -protokolle gefördert. Die Injektion von Phosphatidylcholin/Desoxycholsäure in subkutanes Fettgewebe hat die minimal-invasive ästhetische Medizin, bei strenger Indikationsstellung und nach intensiver Schulung der die Methode einsetzenden Mediziner um einen sinnvollen Baustein erweitert.
The subcutaneous injection of phosphatidylcholine-containing substances is a frequently used method to reduce small localized fat deposits. Even though injection lipolysis is generally safe and free of complications, there have been rare reports on poor results, hematoma, infection or localized skin and tissue necrosis. A 28-year-old woman presented with an extensive toxic dermatitis characterized by well defined, erythematous, partly livid plaques as well as severe edema and strong pain about eighteen days after injection lipolysis on the thighs and knees.
Injections with phosphatidylcholine- and deoxycholate-containing substances are used to treat localized fat accumulation and lipomas. It is believed that the injected substances induce fat cell destruction with subsequent acute panniculitis followed by a repair process of the treated fat tissue.
We investigated whether necrosis or apoptosis of fat cells was induced by the injected substances.
Samples of fat tissue of lipoma were collected at various times after injection and evaluated by light and electron microscopy, by immunostaining for active caspase-3 and antideoxyribonuclease I, in situ end-labelling (TUNEL staining), and biochemical caspase-3 assays.
Light and electron microscopy showed fat cell necrosis in all areas of the treated lipomas. Low levels of active caspase-3 indicated the absence of apoptosis.
Injection of the lipolytic substances phosphatidylcholine and deoxycholate leads to fat cell necrosis rather than apoptosis. However, additional studies evaluating different dosing and further time points after treatment are necessary.
Lower eyelid fat should be preserved in rejuvenation procedures of the eyelids ana race, rnë removal of lower eyelid fat in conventional blepharoplasty techniques frequently results in an operated appearance of a hollowed lower eyelid. The combination of arcus marginalis release and preservation of the orbital fat and repositioning the fat over the orbital rim creates a more youthful contour of the eyelid-cheek complex.
Effects of lipostabil-forte containing unsaturated fatty acids on serum lipid concentrations, plasma and erythrocyte lipid and phospholipid fractions, immunoreactive insulin and thyroidal hormone levels were studied in 30 patients with coronary heart disease. During the therapy of all the patients within 1 month and occasionally 3 and 6 months, there was a statistically significant reduction in serum triglycerides, an increase in relative erythrocyte phospholipid levels and in plasma and erythrocyte phosphotylcholine, as well as reversal of hyperinsulinemia and improvement of thyroid function.
The presence of puffy, baggy lower eyelids is one of the first signs of the aging face. Baggy eyelids can result from excessive eyelid skin, hypertrophied orbicularis muscle, and/or periorbital fat herniation. An exact diagnosis of which components are contributing to the problem must be made in the preoperative period so that proper correction can be made during surgery. The concept of true periorbital fat herniation in the causation of baggy lower eyelids is presented. The surgical correction of this anatomic defect involves identification and approximation of the dehiscent orbital septum to the capsulopalpebral ligament. Thirty-five patients who presented with true lower eyelid fat herniation and who underwent direct suture repair are reviewed.
Grafting small pieces of fat for preventing or correcting depressions of the septal portion of the lower lid is a relatively simple procedure. Over the past years the authors have used this technique frequently in both iatrogenic and congenital cases. Through a stab incision in the lower lid, biopsies have been taken, and the grafted fat macroscopically and microscopically had the appearance of normal tissue. Both the surgeon and the patients have been pleased with the short-term and long-term results of these free fat grafts. The authors are very satisfied with the new technique devised whereby the fat from the mesial and inner fat pads is slid toward the nasal and cheek regions to fill deep nasojugal depressions.
Preservation of lower orbital fat in facial rejuvenation is a new concept for preventing the "operated" appearance that may follow fat removal in conventional blepharoplasty. By creating a narrower, more shallow orbit, the surgeon can create a truly youthful eyelid-cheek complex. Orbital fat advanced over the complete inferior orbital rim hides the bony framework that becomes apparent with normal aging. This technique is used routinely in isolated blepharoplasty and with composite rhytidectomy. It accompanies repositioning of the orbicularis oculi muscle, cheek fat, and facial platysma muscle. It is a procedure that can correct postoperative problems caused by excess orbital fat removal, lower eyelid retraction, and contour problems resulting from malar augmentation. The orbital fat is one of the many deep "pieces" of the human face that must be preserved and repositioned for optimal facial rejuvenation.
Comparative effect of eiconol (resource of omega-3 PUFA) and lipostabil on lipid, biochemical, hemostatic parameters in blood and activity of lipolytic enzymes in thrombocytes and monocytes was studied in 18 clinic patients with ischemic heart disease fed antiatherosclerotic diet during 2 weeks. On basis of these parameters was concluded that eiconol and lipostabil showed the strong hypolipidemic effect. Fibrinolytic effect showed only eiconol. The results showed that hypolipidemic and fibrinolytic actions more strong at treatment by eiconol.
In ethanol-fed rats, supplementation of the diet with soybean polyenylphosphatidylcholine (3 g/liter for 21 days) markedly decreased postprandial VLDL-triglycerides and both VLDL- and LDL-cholesterol levels, whereas it maintained high levels of HDL-cholesterol, compared to an equivalent intake of choline and polyunsaturated fatty acids. By contrast, there were no changes in the serum lipoproteins of the pair-fed controls. The prevention of alcoholic hypertriglyceridemia was associated with marked attenuation of the alcoholic fatty liver and it occurred despite a slight increase in fat absorption. Thus, the administration of polyenylphosphatidylcholine not only attenuates the hepatotoxicity of ethanol, but also increases the HDL/LDL cholesterol ratio, which may be beneficial for the prevention of atherosclerosis and coronary heart disease.
To define the anatomy and location of malar folds as distinguished from lower eyelid skin and orbital fat and to teach a new surgical technique for the management of the aging eye.
Retrospective report of a surgical procedure designed to address the malar folds.
Analysis of preoperative and postoperative photographic documentation for surgical planning and long-term result.
Patient satisfaction and lack of recurrence, without the requirement of direct excision, were noted in all patients studied.
This presentation describes a new simple technique for the management of the folds and cutaneous and subcutaneous prominences that occur inferior to the lower eyelid skin. The operation addresses the correction by a combination of skin/muscle flap lower eyelid blepharoplasty with immediately subcutaneous (skin flap) elevations over the carefully delineated malar prominences; the removal of the deep fat that may or may not be associated with dehiscence of fat through the thin inferior fibers of the orbicularis muscle; and finally suspension of the remaining subcutaneous tissue and the muscle to the periosteum of the inferior orbital rim as well as suspension of the orbicularis muscle margin to the lateral orbital periosteum or the lateral canthal ligament area. The technique is designed to manage the more commonly found malar prominences but can be applied in the management of more pronounced festoons involving skin, muscle, and fat.
The standard treatment for herniated "bags" of the lower eyelid is surgical removal of excess fat. Sachs and Bosniak in 1986 and de la Plaza and Arroyo in 1988 described a new technique for treatment of palpebral bags that consisted of returning the herniated fat to the orbital cavity and retaining it by continuous sutures of the capsulopalpebral fascia either to the dehiscent portion of the orbital septum or to the periosteum of the lower orbital rim. This article reports a prospective study of 26 patients who underwent standard blepharoplasty in one lower eyelid and capsulopalpebral fascia hernia repair in the other lower eyelid. All were evaluated at 6 weeks and at 6 months after surgery, and the outcomes were compared. The results of the two different techniques in the same patient have shown comparable aesthetic outcomes in the treatment of palpebral bags. However, results indicate that the capsulopalpebral fascia hernia repair technique carries less discomfort and pain during the operation and may be less prone to postoperative bleeding and hematoma formation. In addition, in contrast to standard lower blepharoplasty with fat resection, hollowing of the lower lid or potential sunken appearance of the globe may remain absent with capsulopalpebral fascia hernia repair beyond the 6-month period of this study.
Experimentation clinique du lipostabil dans le traitement des angiopathies diabetiques
- H Warembourg
- J Jaillard
Warembourg H, Jaillard J. Experimentation clinique du lipostabil dans le traitement des angiopathies diabetiques. Lille Med 1968; XIII(suppl):721–3.
Management of malar folds in blepharoplasty Figure 1. A 71-year-old patient with prominent fat pads. B) Postprocedure view after three injections of phosphatidylcholine. Figure 2. A 55-year-old patient with prominent fat pads. B) Postprocedure view after four injections of phosphatidylcholine
- Rt Farrior
- Kassir
Farrior RT, Kassir RR. Management of malar folds in blepharoplasty. Laringoscope 1998;108:1659–63. Figure 1. A 71-year-old patient with prominent fat pads. B) Postprocedure view after three injections of phosphatidylcholine. Figure 2. A 55-year-old patient with prominent fat pads. B) Postprocedure view after four injections of phosphatidylcholine.
- Parsa
- Farrior