Mesotherapy is a form of medical therapy utilizing cutaneous injections containing a mixture of compounds for the treatment of local medical and cosmetic conditions, including treatment of localized fat deposits. Phosphatidylcholine / deoxycholate injections are a popular technique to treat localized fat accumulations and have become synonymous with mesotherapy.
The present study investigated the efficacy, safety and the possible mechanism of action of lipodissolve injections. Both in vivo (human: n=30 female; rat: n=15) and in vitro (n=10 human subcutaneous fat specimens) studies were done.
The in vivo human study included thirty female patients with localized subcutaneous fat deposition in the abdominal region. Patients were informed in detail about the procedure. They were divided -according to the injected material-into 3 groups: group (A) Phosphatidylcholine 'dermastabilon' (n=10), group (B) Sodium deoxycholate 'deoxylyse' (n=10) and group (C) Phosphatidylcholine + organic silicium 'silorg' (n=10). Age range of the included patients was 21 - 45 years with body mass index ranged from 24.5 to 30 kg/m2.
Two sessions of injection were done with four weeks interval. The abdominal region was marked by injection points. The distance between injection points was 1.5 cm. The dose of injection per point was 0.3ml and at 13ml depth. The total dose per session ranged from 750 ml to 1000 ml. The abdominal region was massaged after injection.
Follow up of the patients included photography, abdominal circumference measurement, abdominal ultrasonography, laboratory evaluation, assessment of adverse effects (local, systemic) and histopathological examination of subcutaneous fat. Reduction of the abdominal fat layer thickness was obtained in each studied group with no statistically significant differences among the three studied groups with respect to changes from baseline mean values regarding reduction in body weight, body mass index, mean abdominal circumference and mean ultrasonometric measures. Histologic study showed fat cell lysis ,neutrophilic infiltrate and fibrotic changes . Most of the side effects were few, local and transient. No significant laboratory changes before and after treatment in each studied group.
In vivo rat sudy was included in the present work, in order to determine the safest and the most effective dose of dermastabilon or deoxylyse. Rats were divided into 3 groups- according to the injected dose of dermastabilon or deoxylyse delivered at the center of the 1-cm2 area: group (A) 0.1ml per 1 cm2 (n=5), group (B): 0.3ml per 1 cm2 (n=5) and group (C) 0.6 ml per 1 cm2 (n=5). Each rat was injected with dermastabilon on one side of lower abdominal region and the same dose of deoxylyse on the contralateral side.Each rat being itself the control.
Rats were observed for 2 weeks. Skin and muscle biopsies were taken from the injected sites to determine the effects and local complications of different doses. We observed skin ulcers and necrosis of muscle tissue underlying subcutaneous fat. These effects were apparent only with the two higher doses of dermastabilon and deoxylyse. The safest effective dose was 0.3ml /cm2 with increasing inflammatory and muscle changes with increasing the injected dose. There was no significant difference between dermastabilon and deoxylyse at the same dose regarding skin affection, fat cell lysis, neutrophilic infiltrate and cutaneous muscle affection.
To determine the direct detergent effect of lipodissolve materials ,in vitro study was done by comparing dermastabilon , deoxylyse , dermastabilon plus silorg and saline 0.9% through naked eye observation of the degree of fat dissolution over 24 hours , then pathplogical examination for fat necrosis. Significant differences were found between dermastabilon, deoxylyse and dermastabilon plus silorg in comparison with normal saline regarding fat liquefaction and fat cell necrosis over 24hours.
Conclusions that may be made from this study:
1-Dermastabilon exerts a detergent effect to lyse cell membranes, although its action may not end here.
2-Sodium deoxycholate is a major active component of the formulation and not only a dissolvant to phosphatidylcholine but has alipolyic effect.
3-Additives as organic silicium (silorg) may give better results with synergistic effect in inducing reduction of subcutaneous fat.
4-Injection lipolysis is an effective and safe alternative procedure to liposuction for patients with small sized fat deposits who do not want to undergo surgery.
5-Our histologic data in human and rat show unspecific cytotoxic effect of phosphatidylcholine (dermastabilon) and sodium deoxycholate (deoxylyse) involving not only fat cells but also muscles and blood vessels.
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