Indications and Contraindications for Treatment

 

Injection lipolysis is not meant to be a “one size fits all” cure for fat deposits. It is a finesse treatment, and should only be used in small regions, not for obese patients. Because the amount of fat reduction per injection session is the same, regardless of the area treated, it makes sense that patients with tiny areas of localized fat will see great results, and those with a large amount of fat will see a lesser result.

Injection lipolysis, when done correctly, can be of benefit for the following indications:

1. Small, well localized regions of diet and exercise resistant fat deposits. Soft fat responds better than firm, fibrous fat. The treatment region should be <300 cc, roughly the size of a 12 oz soda can. Best results are seen in the 3 cc to 100 cc reductions.

2. Areas of very mild skin laxity with underlying fat. If the skin is slightly flabby, a nice correction with about 10-14% skin retraction can be seen, depending on skin quality. In areas where the skin is thick, less improvement is seen. Regions that respond well are jowls, small submental fat deposits, upper arms, inner thighs, and some abdominal regions. Back rolls can really improve unless the skin is very thick. However, if there is an extreme excess of extra skin, injection lipolysis is not indicated.

3. Cellulite. Patients with all grades of cellulite, I-IV, can see some improvement with treatment. Usually we combine injection lipolysis with ultrasound treatments in order to get the best correction, as cellulite is more difficult to treat successfully than simple fat deposits. At least three injection sessions are required for a definite difference to be visible. Improvement, not perfection, is able to be obtained.

4. Lipomas. While only 1% of the population has lipomas, those that do sometimes have lots of lipomas in assorted locations. Instead of having to have these surgically removed, lipomas can be injected with PC/DC for reduction and eventual elimination. There have been no long term studies to show whether or not treated lipomas regrow or recur. A stronger deoxycholate solution can be used to treat these, as the goal is elimination of the lipoma, but these injections are quite a bit more painful than the standard injection solution.

5. Post liposuction contour irregularities. Although only about 5% of patients who have undergone liposuction have surgical revisions, plastic surgeons who perform the procedure estimate that up to 40% of their patients would benefit from a minor contour correction. Mild protuberances or “divots” that cannot really be improved reliably with surgery can definitely be improved with injection lipolysis. The cost to the doctor and patient is minimal. Again, improvement of mild contour irregularities is expected, but perfect contour and symmetry cannot be achieved.

6. Post facelift and post fat grafting asymmetry. It’s not uncommon for patients who have had a face or necklift to have a little recurrent “jowling” a year or more after the surgery. Instead of returning to the operating room for another procedure, mildly drooping jowls can easily be treated with injection lipolysis. If fat grafting “takes” more on one side than another, a minute injection of PC/DC can reduce the excess much more precisely than surgery or Kenalog injections can.

 

CONTRAINDICATIONS

There are instances when patients should absolutely not be treated with injection lipolysis, and some instances in which the situation is not so clear.

ABSOLUTE CONTRAINDICATIONS:

1. Pregnancy, or the possibility of being pregnant
2. Women who are breast feeding
3. Children under age 18
4. Allergy to soy, cattle bile, or benzyl alcohol
5. Open sore or infection in or near the treatment region
6. Ischemia or poor quality, heavily scarred tissue in the treatment region
7. Severe systemic illness such as cardiac problems, oxygen dependence, or renal failure patients on dialysis
8. Immunosuppression or recent chemotherapy. This includes patients on more than 5 mg/ day of prednisone.
9. Anticoagulation including Heparin, Plavix, or Coumadin
10. Treatment region over 600 cc total (300 cc each side)
11. Brittle insulin dependent diabetes
12. Scleroderma or systemic lupus

 

RELATIVE CONTRAINDICATIONS:

1. Unrealistic expectations
2. Type II diabetes on oral hypoglycemic
3. General obesity
4. Chronic illness such as mild renal failure, congestive heart failure
5. On aspirin or NSAIDS
6. Treatment area has broad surface
7. Autoimmune disease, mild

 

An honest prediction about the degree of improvement possible with this treatment is mandatory. Many patients secretly hope for lipolysis to be the “magic wand” that will “melt away” all of their unsightly fat. It won’t. Lipolysis is meant to be only a finesse procedure. It can help small problems but not large ones. Treatments are not totally benign; they involve some temporary discomfort, profound swelling, and healing over a period of 6-8 weeks. The keys to success are choosing the right area in the right patient (for the doctor) and in choosing a detail oriented physician who carefully performs the correct technique using the right formula (for the patient).