The topic of injectable lipolysis has long been hotly debated among aesthetic medicine doctors. On the one hand, this is a relatively quick way to deal with local fat deposits, on the other hand, this procedure requires considerable knowledge from the doctor, and not only in the field of aesthetic medicine. All this creates a lot of nuances and additional selection criteria when prescribing this technique to a patient with localized fat deposits.
Injection methods for the correction of local fat deposits gained fame at the beginning of the 21st century thanks to the work of Dr. Patricia Rittes (Brazil), who first used a solution of phosphatidylcholine and sodium deoxycholate for this purpose. Since then, both small uncontrolled studies and double-blind trials have been conducted on the topic of injectable lipolysis.
It is very important to distinguish between the two main directions in the fight against subcutaneous fat by injection: lipolysis and liporeduction. When performing liporeduction, the splitting of triglyceride molecules in the fat vacuole of the adipocyte to glycerol and fatty acids is activated. This happens due to the activation of a specific receptor on the surface of the fat cell by a signal peptide (growth factor or its synthetic analogue). With liporeduction, the adipocyte remains viable. Injection lipolysis is the chemical destruction of adipose tissue by introducing natural detergents into it, like bile salts. In this case, the cell membrane of the adipocyte is destroyed by the mechanism of solubilization and its death. Here we will talk about LIPOLYSIS.
Composition and mechanism of action of modern lipolytics
All modern lipolytic agents contain sodium deoxycholate or its mixture with phosphatidylcholine as an active ingredient. Deoxycholic acid – bile acid synthesized naturally in the gastrointestinal tract by dehydroxylation of primary bile acids. Sodium deoxycholate – salt of deoxycholic acid, formed in the liver when deoxycholic acid binds to an amino acid. Deoxycholic acid and sodium deoxycholate are amphiphilic compounds and have detergent properties. They emulsify fats to form micelles, while sodium deoxycholate is more active.
Phosphatidylcholine (lecithin) – the main lipid component of the plasma membrane of the cell and the membranes of subcellular organelles. When dispersed in the aqueous phase, phosphatidylcholine forms liposomes.
A lot of scientific research is devoted to explaining the role of each of these substances in the process of lipolysis and determining the degree of their damaging ability for other cells, determining the ability to cause inflammation.
In 2008, a double-blind, randomized study was conducted that showed fewer ecchymosis, indurations, and pain in patients with the introduction of a solution of phosphatidylcholine/sodium deoxycholate compared with mono-administration of deoxycholate.
Already in 2014, Korean scientists in the course of their study conclude that deoxycholic acid plays a key role in the inflammation caused by the administration of a solution of deoxycholic acid / phosphatidylcholine. Mono-administration of phosphatidylcholine during this study did not cause an inflammatory response (no increase in myeloperoxidase activity was observed, the level of IL-1B, IL-6 and prostaglandin E2 remained normal). With mono-administration of deoxycholic acid, an increase in the above markers of inflammation, an increase in edema and polymononuclear infiltration was observed. Phosphatidylcholine has not been proven to exacerbate inflammation caused by deoxycholic acid.
Thus, experiments show that a mixture of phosphatidylcholine and sodium deoxycholate is less aggressive than sodium deoxycholate alone.
Phosphatidylcholine is not a detergent, it was first added to the main active ingredient (sodium deoxycholate) empirically, and now only detailed explanations of its mechanism of action in the context of injectable lipolysis are emerging.
So the American researcher Dr. Diane Irwin Duncan talks about the peculiarities of the mechanism of action of phosphatidylcholine – the formation of liposomes, which, in her opinion, helps to delay the reaction of the tissue. She states that it is impossible to speak of a decrease in the toxicity of the lipolytic solution of deoxycholic acid when phosphatidylcholine is added to it, since signs of inflammation persist. Rather, it can be called a decrease in the likelihood of an immediate loss of cell viability, externally manifested as less intense signs of inflammation.
There are several more ways to reduce the aggressive action of sodium deoxycholate in relation to nearby organs (skin, muscles), which are also already used in modern lipolytics. For example, "immersion" active substance into the structure of the gel to reduce its diffusion in the tissue, the use of a special fan technique of introduction, the addition of a solution of lidocaine, the appointment of wearing compression underwear after the procedures.
All these methods can significantly reduce the likelihood and severity of adverse reactions that occur during and after the injection lipolysis procedure, such as pain, swelling, ecchymosis, seals.
But is this something that a practicing cosmetologist should be seriously afraid of
Of course, the ideal injectable lipolytic should be devoid of those unwanted reactions that patients are so unhappy with, but every doctor understands that any injection effect on the tissue will cause inflammation.
Injection – this is already damage, not to mention such a process as injection lipolysis. First of all, you should think about the systemic processes in the body.
What should be considered when prescribing injection lipolysis?
Please note that this procedure has a systemic effect. After some of the adipocytes have died, their contents, together with the toxins that were deposited in them, with the residual volume of the drug, will enter the systemic circulation with the lymph flow and be utilized in the liver, excreted through the kidneys. And given that in the area of local fat deposits, blood and lymph flow is often difficult and congestion is observed, it becomes necessary to think about the evacuation and disposal of these products.
This is the list of contraindications for injectable lipolysis:
- chronic or acute liver disease;
- renal failure;
- diabetes mellitus;
- heart disease;
- circulatory disorders (lymphostasis, varicose veins).
This is not a complete list of contraindications, but already from this we can conclude that some of our patients have contraindications for injectable lipolysis, which they may not be aware of. In the absence of clinical examination, the cosmetologist – often the only doctor in the last few years who observes the patient, and many of the listed diseases can occur subclinically. Therefore, it is necessary to carefully collect an anamnesis, prescribe the necessary studies. It is not unusual for a cosmetologist to refer you for a complete blood count or ultrasound.
In case of local disturbance of the outflow of blood and lymph in the presence of cellulite, the procedure can be performed, however, in the post-procedure period, lymphatic drainage procedures are indicated, such as vacuum-roller massage, and wearing compression underwear.
Injection lipolysis is a procedure that gives hope for an ideal figure for people without obesity, but with local fat deposits. Within its indications, injection lipolysis even has some advantages over liposuction. Do not avoid lipolysis in your practice, you must carefully examine the patient.
According to 1nep.ru
Performing any cosmetic procedures or manipulations of the facial area inevitably requires knowledge of the anatomy and topography of the formations of this zone from the specialist. There are several important aspects that the doctor needs to evaluate before starting work:
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