25 August 2020
Mesotherapy lipodissolve– you may be familiar with popular aesthetic treatments in Singapore such as Rejuran Healer, Skinboosters and threadlifts and Profhilo. However, one cosmetic treatment that you might not be familiar with is mesotherapy fat dissolving injections. Mesotherapy (also referred to as injection lipolysis or lipodissolve) is a controversial treatment that is banned in Singapore and several other countries.. This blogpost will look at what mesotherapy is and the controversies and risks of fat melting injections. Safer and approved alternative treatments for contouring the face and body will also be covered in this review.
Mesotherapy is a method of fat reduction and contouring by destroying fat cells. It is also colloquially known as fat dissolving injections. Mesotherapy or fat dissolving injections involve injecting medications into specific areas of the face or body to eliminate the fat cells. These injections may also include hormones, vitamins and plant extracts.
Although mesotherapy is synonymous with fat dissolving injections, the original indication for mesotherapy was to manage painful indications. The term ‘meso’ means middle and mean; in reference to the injections into the middle of the skin (intradermal) and dose of medication in between allopathy and homeopathy. The original description of mesotherapy denotes a method of delivering drugs into the skin; and not a treatment of any medical condition.
The technique of mesotherapy was developed by a French doctor, Dr Michel Pistor, in 1952. Dr Michel Pistor originally described the technique to treat pain and vascular conditions. It began when Dr Michel Pistor injected an anaesthetic, Procaine, into the bloodstream of a deaf patient with asthma. The patient’s asthma did not improve, but his hearing did. With this fortuitous occurrence, Dr Michel Pistor continued to inject procaine around the patient’s ear. The patient’s hearing improved after these injections
Dr Michel Pistor continued to experiment with superficial injections around the ear of patients with hearing loss. The results of his experiments were mixed. Dr Michael also continued to experiment with superficial injections of Procaine for different conditions and published his experience in a French medical journal in 1958. In his description of mesotherapy, Dr Michel Pistor defined mesotherapy as treatment of the mesoderm (the layer of cells from which many other tissues like connective tissues, muscles and circulatory systems develop from).
In France, mesotherapy is recognised as a legitimate treatment modality. Mesotherapy is practised in some pain management centers in France.
In cosmetic treatments, mesotherapy involves injecting substances into the skin or subcutaneous fat for fat removal, skin rejuvenation, cellulite removal and hair loss. This review will focus specifically on mesotherapy for fat removal as this is the most common association.
Fat dissolving injections are often promoted as a non-surgical and minimally invasive method for removing unwanted fat in the face and body. In most countries, mesotherapy for fat removal is not recognised as a legitimate treatment. Currently, there is a lack of scientific studies to support the efficacy and use of the procedure for fat removal. In Singapore, mesotherapy lipolysis is banned by the Ministry of Health.
Save for Kybella/ Belkyra (see below) which is US FDA approved; no regulatory body worldwide has approved injectable therapy (lipolysis) for fat removal.
The exact ingredients used in fat dissolving injections are not standardised. The choice of ingredients depends on the injector. As there are no approved medications for lipodissolve mesotherapy; the use of such medications are unapproved and unregulated. The most common ingredients used for mesotherapy fat reduction are phosphatidylcholine and deoxycholate. When injected into superficial subcutaneous fat, these ingredients induce death of the fat cells and inflammation. This results in fat reduction in the treated area.
Phosphatidylcholine is a substance that is naturally found in our bodies. The main function in our bodies is to emulsify and break down cholesterol and fats, a process known as lipolysis/ lipodissolve. Phosphatidylcholine used for lipodissolution is derived from soybeans. Deoxycholate is another substance that also disintegrates fat cells. Other ingredients that have also been used for fat dissolving injections are a cocktail of vitamins, enzymes and hormones.
One example of injection lipolysis is Kybella. Kybella is a drug that has received US FDA approval for non-surgical treatment of submental fat i.e. double chin.
Kybella (also known as Belkyra in Singapore) was launched in the US in 2015 to much fanfare from doctors and patients. Kybella contains sodium deoxycholate or ATX-101. When Kybella/ Belkyra is injected into the submental fat of the double chin, sodium deoxycholate/ ATX-101 causes lipolysis by disintegrating the membrane of the fat cells. Kybella/ Belkyra also tightens the skin in the neck by enhancing collagen formation. The overall results of Kybella/ Belkyra are reduced double chin bulge and sharper and slimmer jawline-neck angles.
You can read more about alternative double chin treatments and Kybella/ Belkyra in this blogpost Double Chins: Double Trouble Gone Forever. *Please note that administration of Kybella/ Belkyra for double chin fat reduction is not allowed in Singapore.
Mesotherapy fat dissolving injections are for treating specific superficial areas of fat in the face and body. The objective of fat melting injections is contouring, not weight loss, although in Korea, some doctors have noted a reduction in their patients’ Body Mass Index (BMI). Some of the areas of the face and body that have been treated with lipolytic injections are:
• Face: Eye bags
• Neck: double chin/ submental fat and aging neck
•Body: localised fat in the abdomen, thighs, arms love handles and buttocks
Some of the reported side effects and complications of mesotherapy fat dissolving injections are:
• Pain, redness
• Massive swelling
• Burning sensation
• Allergic reactions
• Fat necrosis
• Permanent scarring
Mesotherapy lipolysis is a broad term to describe injections into the skin to remove superficial areas of fat. Currently, there is no consensus for approved formulations and standards for administering these injections.
The lack of adequate understanding of fat dissolving injections have also called into question the safety and efficacy of this treatment. The lack of regulations and standardised protocols for mesotherapy have led to the use of questionable off-label uses of medications and unscientific cocktail compounds. The complications of these injections can be devastating.
Even Kybella/ Belkyra is now dealing with a backlash; five years on from its highly anticipated launch. Now that the dust has settled for Kybella/ Belkyra since its release; some plastic surgeons and dermatologists in the US are finding this treatment to be underwhelming. Some of the factors cited were the enormous downtime for relatively little results each session and higher total cost for Kybella/ Belkyra treatments compared to neck liposuction.
Singapore’s Ministry of Health has banned mesotherapy for cosmetic treatments. MoH’s take is that mesotherapy has little scientific merit. Other treatments that have been banned by Singapore’s Ministry of Health are platelet rich plasma facials (aka Vampire Facelift) and skin bleaching drips.
There are safe and approved alternatives to mesotherapy fat reduction injections in Singapore. Here are the non-surgical options for removal of unwanted fats:
• For eye bags: Under eye fillers
• For double chin: Neck threadlifts, cryolipolysis, HIFU
The history of mesotherapy is a convoluted one. The term mesotherapy originally referred to intradermal injections; and encompasses a broad range of treatments. In cosmetic treatments, mesotherapy fat reduction injections refer to injections of cocktails of vitamins and substances to induce lipolysis for face and body contouring.
Mesotherapy fat dissolving injections are fraught with controversies and safety concerns. The scientific merit of this treatment is questionable and this treatment is banned in Singapore. The lack of standardisation of treatment formulas and techniques has also led to unscientific and unapproved use of medications. The complications of mesotherapy lipolytic injections can be devastating- panniculitis, infections and permanent deformities.
Kybella/ Belkyra is a drug for removal of submental fat (double chin) that received US FDA approval in 2018. It contains deoxycholic acid (ATX-101). Kybella/ Belkyra was billed as a non-surgical alternative to liposuction of submental fat. Some plastic surgeons and dermatologists in the US have shared that the results Kybella/ Belkyra have been disappointing. The recovery time from the massive swelling and multiple sessions required have made liposuction a better option for some patients. Lastly, mesotherapy fat reduction injections are not approved in Singapore for cosmetic treatments. Currently, other than Kybella/ Belkyra, no regulatory body in the world has approved medications for injection lipolysis. There are safe and approved non-surgical alternatives to contouring the face and neck that you can consider instead.
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3. The lipodissolve technique: clinical experience. Rittes. Clin Plast Surg. 2009 Apr; 36 (2): 215-21, vi; discussion 223-7.
4. Injectable therapies for localized fat loss: state of the art. Duncan and Rotunda. Clin Plast Surg. 2011 Jul;38(3):489-501, vii.