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Are There Alternatives to Liposuction?

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Q: I am a fit 54 year old, have had a face lift and look good for my age, but I have a few fatty deposits over my hips and cellulite that don't go away with exercise and are driving me crazy. I have heard of nonsurgical fat removal - is there any way, shy of having liposuction, which will remove my cellulite and fatty deposits?

A: First of all, congratulations on being fit at 54 and for caring how you look! General health wise, there is nothing better that you can do for your body than to keep fit and to keep excess weight off!

In order to answer your question, I'd first like to give you some background about fatty deposits and cellulite. We all have fat within our bodies, some fat is necessary, but too many of us have an excess of fat. Our body needs energy to survive, and that energy comes from what we eat or drink. No matter whether you are consuming protein, carbohydrates or fat, the body breaks down the food you take in into tiny molecules. The body uses what it needs to survive, and all of the excess, no matter whether it started as protein, carbohydrates or fat, gets converted by the liver into fat. This fat is transported by the blood to fat cells throughout the body for storage. On days when you do not consume as many calories as are needed for survival, the stored fat gets returned to the liver where it is re-manufactured into usable parts throughout the rest of the body. We all know that fat is stored in different ways and places in different people. Women tend to store their excess fat over the hips, thighs and in the external layer, between the skin and muscles, over the abdominal wall. Men tend to store their excess abdominal fat internally, around the intestines, as well as externally over love handles and the chest.

Cellulite refers to the surface irregularities seen over the thighs, hips, and buttocks of almost all women, and is rarely seen in men. Men and women store fat differently under the skin, men more in horizontal layers with a smooth surface, while women store the fat more in a perpendicular manner, which leads to the objectionable surface lumpiness.

Now that we understand about excess fatty deposits and cellulite, let's discuss what can be done to improve cellulite or remove unwanted fatty deposits. Let's start with cellulite. There have been many, many treatments varying from home remedies, commercially available creams and ointments, wraps, garments and machines that have been promoted as providing cures for cellulite. It has also been claimed that caffeine, through its ability to constrict blood vessels, can make your skin appear tighter and improve cellulite.

I well remember when, about 20 years ago, Endermologie was introduced, received a lot of interest from the press and doctors were lining up to purchase these $150,000 machines. These machines basically used rollers that the company claimed, sent a message to the cells, triggering actions such as fat break down and collagen production. The company claimed that cellulite was removed and inches would come off the treated areas. Multiple treatments were required. After any one treatment, the cellulite did seem to improve, probably from the swelling caused by the localized trauma, but unfortunately, a month later, when it was "time for another treatment", all the cellulite would be back in its full glory. What patients ended up with was basically an expensive massage! This machine simply did not live up to its claims or patient expectations.

Next came mesotherapy or Lipodissolve, a "non-surgical alternatives to liposuction". Mesotherapy involves a series of injections that may melt away unwanted small, localized areas of fat. While the main ingredients used in these injections vary, the chemical cocktail typically includes phosphatidylcholine/deoxycholate (PCDC), multivitamins, alpha lipid acid, enzymes and plant extracts. Phosphatidylcholine is FDA-approved to break down blood fats that may increase risk for heart disease, but it is not approved for injection or any other purpose. Use of this substance to dissolve superficial fat is performed in an off-label manner. During these treatments, your doctor injects the chemical cocktail into the fat layers. The injection is relatively painless, with no need for anesthesia. The medication produces a chemical reaction which dissolves localized areas of fat. Benefits can be seen within three weeks of the treatment but proponents claim that several treatments, four to six weeks apart, are required to produce the optimal result. After a treatment, the patient can return to their usual activities. Approximately 100,000 Lipodissolve treatments have been performed in the United States and Europe and some papers have been written, showing post treatment improvement, but problems remain, and because of these problems, Kansas and Nebraska, are in the process of enacting legislation to ban Lipodissolve. ANVISA, the Brazilian version of the FDA, banned the use of phosphatidylcholine-based products for injectable fat removal, and Health Canada, the Canadian FDA, has ordered physicians to stop marketing and administering the products. We know that these injections can liquefy fat, but where the fat goes is anyone's guess. Harmful deposits in the liver or blood vessels could lead to serious medical problems including fatty plaque and increase the risk of heart attack or stroke. The American Society for Aesthetic Plastic Surgery (ASAPS) has reported that infection, disfiguring masses of inflamed tissue and tissue death can occur after Lipodissolve. I have seen a number of previously treated patients with indentations in the treated sites. Ignoring the health issues, from a purely aesthetic point of view, the main problem with Lipodissolve is that the results are unpredictable and that surface irregularities are quite common. Lipodissolve is still in the experimental stage. Clinical studies in the United States that look at the safety and efficacy of Lipodissolve are underway. This is a treatment that we would only recommend under special circumstances at this time.

The latest nonsurgical technique which is being touted as a magical cure for cellulite and fatty deposits is Cryolipolysis, using a machine built by Zeltiq, and promoting a "One hour fat fighting treatment". This is a new technology with very little published information and their machine is not FDA approved yet. From what I've read, probes are placed on the skin that cool the fatty layer to about 5 degrees Celsius, about the temperature in a refrigerator. This damages the fat cells and some will die over the next four months. This procedure does not work on large people, or those with a thick fatty layer because the cold cannot penetrate more than a few cm. But for thin people with very small fatty pockets, it might show some promise. The reason it is not FDA approved yet is because there are questions as to what this cold treatment does to nerves, blood vessels, skin, muscle, etc. long term. I see similar question to those discussed above with the Lipodissolve - where does the fat go, what are the health risks? I simply do not think that loosing an inch off your hips is worth an earlier heart attack!

To summarize, simply put, nothing tops liposuction when it comes to the removal of unwanted fatty deposits (as long as skin laxity is not an issue - if it is, a skin resection may be indicated).

Liposuction is the only scientifically proven method for safely removing fat cells permanently and is the top overall surgical cosmetic procedure performed in the United States. A variety of different cannuals are now used for liposuction, but all are inserted through tiny, hidden incisions and recovery after the procedure is relatively quick and uncomplicated. If you have any areas that are of concern to you, your best bet would be to come in to discuss your concerns with a board certified plastic surgeon.


ABOUT THE AUTHOR: DR. JURIS BUNKIS
Dr. Bunkis, MD, FACS of Orange County Plastic Surgery http://www.ocps.com is a Harvard trained, Board Certified Plastic Surgeon and has 30 yrs of surgical expertise. Call OCPS at 949-888-9700, email your questions to info@ocps.com or visit our website http://www.ocps.com for more information.

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