Recent months have had a raft of bad news about injection lipolysis. Two prominent medical spas whose business was providing the popular treatments abruptly closed their doors, leaving patients in the lurch. Then, the Kansas Board of Healing Arts took action to strictly control the practice, a few months after trying to ban it.
Dr. Joel Schlessinger, immediate past president of the American Society of Cosmetic Dermatology and Aesthetic Surgery, warned the society that lipolysis might be neither effective nor safe, and he urged society members not to practice lipolysis until the ingredients used in the injections become Food and Drug Administration approved.
Recent news articles about this increasingly practiced treatment, popularly known as Lipodissolve, have tended to focus on individuals who complain of having permanent nodules or indentations from the procedure or who tell of rushing to the emergency department.
On the Web site www.realself.com
The Web site reported that an analysis of the IP addresses of the reviewers showed that many of the positive reviews came from one of the two now-defunct companies, Go Fig Inc., without the authors identifying themselves, and some came from MedSculpt (both companies are now out of business).
But while agreeing that better regulation might be a good idea, physicians who perform the procedure think that their experience and studies suggest the risks of complications are quite low and the results, in properly selected patients, generally good.
Support for Mesotherapy
"Injection lipolysis is not without risk, but it is pretty darn safe," said Dr. Thomas Wright, an internist who has a cosmetic practice in suburban St. Louis. He has been collecting reports of cases and complications from members of the American Society of Nonsurgical Aesthetics.
In reviewing about 200,000 treatment cases either reported to him or that he has sought out, he has found only 2 definite cases in which there was a serious complication. Both were cases of skin ulceration at or near sites of injection that needed skin graft repair. Overall, he said that he has found about 20 cases of skin breakdown or a pigment change, though some of those were extremely small, a millimeter in size.
He reported having recorded no other confirmed complications.
"We've been using injection lipolysis in my clinic for 2 years now and getting excellent results," said Dr. Charles E. Crutchfield III, a dermatologist who practices in Minneapolis.
Dr. Crutchfield said the only serious complications he has seen or heard of are cases of skin ulceration. It is thought ulceration happens because of injections placed too superficially.
Dr. Crutchfield is a member of the medical advisory board of the American Society of Aesthetic Lipodissolve, a professional organization that owns a copyright on the term Lipodissolve and provides training in the procedure. Dr. Wright is also a medical advisory board member with the group.
Reports of Complications Conflict
Andrew Noel, a photographer from Las Vegas, had treatments at a Go Fig spa, and he said that 4 months after his last treatment, he still has welts "the size of 50-cent pieces" on his abdomen where he received the injections.
"My tummy is disfigured and I am steaming mad," he said.
Dr. Alastair Carruthers, a dermatologist in Vancouver, B.C., has seen two patients who had complications presumed to be from Lipodissolve treatments, the first in a woman who was injected in her lower eyelids and the second in a woman injected in her thighs.
The second woman developed significant ulceration that caused scarring, Dr. Carruthers said.
Dr. Elizabeth Tanzi, a dermatologist in practice in Washington, has seen four patients with complications from Lipodissolve treatment, two with "an unnatural firmness" that resolved only slowly, one with a vascular pattern over the treated area that lasted for a year and required laser treatment, and another patient who had a draining nodule.
But surveys, like Dr. Wright's, of physicians who practice injection lipolysis suggest that the procedurewhile sometimes causing discomfort and leaving temporary nodules in treated areas that resolve over timeonly rarely has complications.
And another survey of 75 practitioners reported that among 17,376 patients treated there were no hospitalizations, no deaths, and no cases of skin necrosis (Aesthetic Surg. J. 2006;26:57585). Moreover, less than 1% of patients reported to their physicians pain that lasted beyond 2 weeks, and the most common complaint of patients was a less than desired result, reported for 12% of patients. Nineteen of the practitioners reported having seen hyperpigmentation, but in the majority of cases this resolved within 3 months.