Small fat pads, e.g. under the chin, can affect the appearance and well-being. The problem may seem too small for surgical treatment in the form of liposuction. Nevertheless, there is dissatisfaction with one’s appearance and possibly comments about the “double chin” from the social environment disturb self-confidence. In these cases, injection lipolysis for the treatment of small fat deposits without surgery can offer a welcome solution.
Injection lipolysis, also known as intralipotherapy, is a non-surgical procedure for the elimination of troublesome fat deposits (lipos = gr. fat) by targeted injection of a special solution into the excess fatty tissue. Common indications for injection lipolysis are smaller fat deposits on the face, such as a double chin or sagging cheeks, as well as small and medium-sized fat deposits on the abdomen, hips, outer and inner thighs and knees, back and armpit folds, and fat deposits on the chest (pseudogynecomastia) and neck (“buffalo hump”).
In contrast to liposuction (lipolysis), the treatment with injection lipolysis does not require anesthesia. Also, there is no need to wear compression garments for several weeks. Thus, the procedure is ideal for patients who shy away from the expense of surgery and the associated aftercare and possible side effects.
What is injection lipolysis?
Subcutaneous fat tissue is distributed differently on the body depending on gender. In women, fat deposits are typically found on the abdomen, hips and outer and inner thighs. In men, fat deposits tend to be arranged in a belt-like pattern on the trunk (abdomen and hips).
This distribution can usually not be influenced by dieting or increased sporting activity. Disturbing fat deposits in the so-called problem zones, e.g. the saddlebags of women, are therefore also found in slim people and are often the reason for a visit to the plastic surgeon.
Although liposuction is reliable, it is also a surgical procedure for the removal of disturbing fat deposits and is therefore not always desired for small problem areas. In these cases, treatments without surgery, such as cryolipolysis (destruction of fat cells by local application of cold), or also injection lipolysis are gentle and safe alternatives.
With injection lipolysis, smaller, localized fat deposits, such as a double chin, can be dissolved by a single or repeated injection of a fat-dissolving (lipolytic) substance, as an outpatient procedure with minimal downtime. For the treatment of large or multiple fat deposits, however, we recommend liposuction, since the injection lipolysis in higher doses is associated with an increased risk of side effects. Thus, injection lipolysis is not a substitute for liposuction in all cases, but suitable for smaller fat deposits.
How does injection lipolysis work?
Adipose tissue in adults consists almost exclusively of white fat cells (adipocytes). These serve to store energy. To do this, they store fatty acids in the form of so-called triglycerides. This storage or depot fat is found in the subcutaneous tissue (subcutis) and on the peritoneum (visceral fat). The subcutaneous fatty tissue serves primarily as an energy storage, as it participates less quickly and strongly in fat metabolism than visceral fat. The build-up of these fat cells also explains why neither exercise nor a change in diet can achieve the desired contour changes in the usual problem areas.
The α-receptors, which are required for the activation of lipolysis (breakdown of fat stores), are missing in certain depots of subcutaneous fat cells or are present in insufficient numbers for fat breakdown. The receptors for liposynthesis (building up fat stores), on the other hand, predominate and ensure that the energy storage is maintained. These fat deposits, which were planned by nature as a useful energy storage, are perceived by many people today as undesirable problem areas for aesthetic reasons.
Dieting can reduce the fat stored in the fat cells, but not the fat cells themselves. The number of fat cells therefore remains the same in adulthood, while the filling and therefore volume of the individual fat cells increases with weight gain and decreases with weight loss. The subcutaneous fatty tissue can be treated with injection lipolysis, while the visceral fatty tissue located deep in the abdomen is not accessible.
Injection lipolysis contains as active ingredients a combination of phosphatidylcholine and deoxycholic acid. Originally, phosphatidylcholine was thought to be responsible for the breakdown of fat. This assumption was based on the fact that phosphatidylcholine was successfully used as an agent against fat embolisms. However, scientific studies have shown that the actual mechanism of action of injection lipolysis is based on the fat-dissolving properties of deoxycholic acid. Deoxycholic acid is a bile acid that also occurs naturally in the human body, where it plays a key role in the digestion of fat.
In injection lipolysis, deoxycholic acid is injected directly into the subcutaneous fatty tissue and binds to receptors on the fat cell membrane. The cell wall becomes unstable due to the fat-digesting effect of deoxycholic acid and dissolves. The fat cell releases its contents, the triglycerides. This results in an inflammatory reaction in the fatty tissue, which is combated by the body’s own immune system. The triglycerides previously stored in the fat cells are released into the blood circulation via the lymphatic system over a period of several weeks and excreted in the urine and stool.
It is assumed that phosphatidylcholine has a positive influence on the further breakdown of fat. This active ingredient, which is produced from soybean oil, causes the fat to be broken down in the liver after the fat cells have disintegrated. Only a small proportion is excreted via the kidneys.
However, a large proportion of these fatty acids are still available as a source of energy. An accompanying change in diet with an exercise program therefore increases the success of injection lipolysis. Otherwise, the result may be pure fat redistribution. According to current knowledge, the fat cells removed with injection lipolysis are not regenerated.
Considerations
Injection lipolysis may be useful for you if the following conditions apply:
- You suffer from excess fatty tissue (fat deposits) in certain areas of the body that appear disproportionate compared to the rest of the body (“problem areas”):
- Double chin
- Sagging cheeks
- Neck fat (“buffolo hump”)
- Fat pads on the armpit creases or knees
- Male breasts (pseudogynecomastia)
- Back fat
- Abdominal fat
- Saddle bags
- These problem areas cannot be eliminated by diet and exercise. This is why they are also referred to as “diet-resistant fat”.
- There is no or only minimal excess skin in the problem areas and the elasticity of the skin is good. As with liposuction, injection lipolysis only reduces fatty tissue and does not tighten the skin.
- The treatment is equally effective for women and men.
- The aim of injection lipolysis is to improve the body contour, not to lose weight.”
Consultation
As with any other cosmetic treatment, the AARE KLINIK for Plastic Surgery also offers a comprehensive consultation with a specialist before any injection lipolysis treatment. Your wishes and expectations regarding the treatment of fat deposits are clarified and the possibilities and limitations of injection lipolysis are explained. After a medical examination and questioning about your state of health and possible pre-existing conditions, you will be informed about the treatment options. Only if injection lipolysis proves to be sensible and promising will the actual treatment be planned, including information about individual risks and side effects.
Injection lipolysis is not suitable for people with the following conditions:
- Acute or chronic skin conditions in the areas to be treated, such as eczema, dermatitis or skin rashes
- Known tendency to severe allergies and in particular anaphylactic reactions
- Severe organ diseases
- Autoimmune diseases
- Diabetes
- Pregnancy or breastfeeding
Procedure
At the Bern AARE KLINIK; all procedures are carefully planned in order to achieve a result that meets the patient’s wishes. For this purpose, standardized digital photos of the body regions to be treated are taken before each injection lipolysis and circumference measurements are taken or the skin fold thickness is determined using the pinch test. The treatment zones are marked to ensure precise planning of the procedure.
Before the actual treatment, the skin in the treatment area is cleaned and disinfected. The deoxycholic acid solution is injected evenly into the subcutaneous fatty tissue of the treatment area in a fan shape via one or more puncture sites using a syringe and the skin is lightly massaged for better distribution and penetration. For a painless treatment, a local anesthetic is added to the injection solution. Finally, a compression bandage is applied for 2-3 days to prevent swelling.
Risks
As with all treatments, certain side effects can also occur with injection lipolysis. However, complications are very rare.
- In the first 1-2 days after the treatment, slight pain in the treated areas is common, which is treated with painkillers, local compression, cooling and, if necessary, lymphatic drainage (twice a week for 2-3 weeks).
- After injection lipolysis, the treated area is usually swollen and feels hard for a few days.
- Bruising, swelling and tenderness may occur in the treated area and the skin may redden.
- In rare cases, hyperpigmentation, loss of sensation, skin necrosis, hardening and irregularities of the skin in the treatment area may occur after injection lipolysis.
- Experiences may vary from person to person. Some patients may experience a delay in the onset of the aforementioned events. Please contact us immediately if any unusual side effects occur or if symptoms worsen over time.
- In rare cases, allergic reactions may occur.
- The effect of injection lipolysis varies individually and depends on the region treated. As with all medical procedures, the desired treatment result cannot be guaranteed in every case.
Preparation
No special preparation is required. Please be sure to inform us of any known allergies before the treatment. Injection lipolysis should not be given if you are known to be pregnant. In this case, treatment should be delayed until after pregnancy and breastfeeding. The best cosmetic results are achieved in patients who have a normal body weight before the treatment.
After Injection
After injection, the damaged fat cells are broken down by the body. This takes place through an inflammatory process, which can be accompanied by swelling and redness in the treatment area. For this reason, a compression bandage should be worn for 2-3 days after the treatment to prevent tissue swelling. Depending on the treatment region and progression, lymphatic drainage over 2-3 weeks may be useful to promote the reduction of swelling. Strenuous activities, such as sport of any kind, should be avoided until the swelling has subsided.
However, normal physical activities, such as working or traveling, are possible, although sunbathing should be avoided for 4 weeks after treatment. An accompanying change in diet is advisable after the fat-away injection in order to avoid redistribution and storage of the triglycerides released from the destroyed fat cells in other parts of the body. Of course, at the AARE KLINIK in Bern, we will tell you everything you need to know after your procedure in order to achieve the best possible results.
Outcome
The changes can be seen after 3-4 weeks. However, the results are most visible after 2-3 months. Your body breaks down the damaged fat cells naturally over several weeks. As a rule, a follow-up check, standardized photo documentation and renewed circumference measurement or final determination of the skin fold thickness (pinch test) is carried out after 2 months, as in most cases a clearly visible treatment result is only achieved at this point. In individual cases, however, the result may be achieved earlier or later. In order to achieve the desired result, it is also recommended that treatments are carried out in several regions or that the treatment is repeated in the same region after 1-2 months.
As the fat cells destroyed by injection lipolysis do not form again in adulthood, the treatment success is permanent and the result is comparable to liposuction or cryolipolysis. With a general increase in weight, however, the remaining fat cells can store more triglycerides, causing the cells to become larger and thus the tissue volume in the treated area can also increase. For this reason, it is important to continue to monitor your diet or change your diet after injection lipolysis in order to maintain the treatment result.
Costs
The cost of a fat-away injection depends on the number of body regions treated and therefore the amount of injection solution (material) and the complexity of the treatment. Depending on the individual response and the size of the fat deposit, it may also make sense to repeat the treatment after 1-2 months in order to achieve an optimal result. An exact cost estimate can therefore only be provided after a personal consultation.
Meet PD Dr. med. Oliver Scheufler
Dr. med. O. Scheufler, specialist in plastic, reconstructive and aesthetic medicine and author of this website, is pleased to be at your service for a personal consultation. Besides his main work at the Aare Clinic, PD. Dr. Scheufler is also scientifically active and has habilitated at the University Hospital of Basel. He was therefore awarded the title of assistant professor by the University of Basel. In addition, he was honored by Duke University (USA) as a Visiting Professor. So do not hesitate to contact him if you wish a professional consultation!