Lipodissolve: Tips and How It Works

Foreign. Talk about lipo dissolve, which is a fat reduction procedure done with a medication that permanently destroys fat cells. And I'm going to tell you just about a brief history. We'll show you some before and after photos. A single treatment, you know, it can be done more than one time. And one of my favorite places to treat it is the subcutaneous fat of the neck. But it can be used anywhere there's fat pockets at. So lipodisol is a term given to a medication that that is made up of a combination of medications called phosphadidylcholine, deoxycholate. And the origins are from the 90s. It was a Dr. Ritz R A T T E S Patricia Ritz from Brazil who used this same drug to treat the little fat pads underneath the eye. And she published it in a journal. And this led it to kind of eventually get to the United States in 2004 where we termed it lipodazole. There's only a handful of doctors doing it at that time. At one time we called it mesotherapy, which was a French term talking about the mesoderm. But the lipidazole is one that kind of stuck. The medication is used in Europe and it's called lipostable. That's a brand name by manufactured drug for intravenous use to break up plaques, soft plaques in the cardiovascular system. And because of this, Dr. Ritz postulated that perhaps it could break up fats injected directly in the adipose tissue. So in about 2004, there was the first lipo dissolve societies identified in America. There's a handful of doctors doing this. Some people again called it mesotherapy, some people lepidosolve. And I was a member of that right from the onset. One of the first doctors, my first eight doctors, doctors doing this in the United States. We again brought it in from South America. And at first we didn't know how much medicine to use which of these components of phosphatidylcholine or the deoxycholine is causing the action of destroying the fat cells. It wasn't crystal clear. And there was a Dr. Patrick Rotunda, he was a dermatology resident, I think UCLA. And he was trying to figure out which component the phosphatidylcholine or deox cholate was actually destroying the fat. So he started experimenting with pig fat, you know, tissue that been removed from a pig and injecting both phosphocholine alone and deoxycholate alone. Even a combination to see it worked. It turns out it was the deoxycholate that was the active ingredient of this phosphatidylcholine deoxycholate, what I'll call pcdc. So long story is that not that made short is that he eventually figured out that you couldn't treat big areas with this because it was too inflammatory. And they came up with a system where you put little drops, micro droplets, just underneath the skin in a grid like fashion. So, so they make a little template to have little dots on it. You put a little micro drop in each spot and put it underneath the skin on the neck and do it multiple times with low dose and people would be able to tolerate the inflammation. And that became called Kybella, which is a Allergan product called Kybella. Well, it never really took off again. Allergan paid a lot of money for this Kybella technology or licensure patent and it wound up delivering as promised. So why not? What happened? Well, it's been shown that if you take the deoxycholate alone or the pcdc, the phosphatidylcholine plus deoxycholate, with the same amount of material, same amount of milligrams of deoxycholate, you get a similar ultimate outcome. The difference is, and it's a massive difference, is that the PC of the PCDC calms down the inflammation of the DC by itself. So DC by itself does destroy fat cells, but it's so wildly inflammatory, creates nodules, a lot of redness, burning and discomfort and pain that we couldn't really treat big areas or do more than a micro dosing. But if we added the PC to it, you could use a lot more of the dc, a lot more drug, get much better result, way less treatments, way less inflammation, way less downtime. So we've come back in full circle. So we were using this since 2004, PCDC and something that we were very successful with for, you know, over a decade before the Kybella came out. When Kybella came out, we tried it. It's like, wow, this stuff doesn't work so good. You can't use nearly as much drug, use about 1, 10 as much DC, getting a lot of inflammation, a lot of pain, and people would need to do about six or seven treatments to see what we're getting in maybe one or two of the pcdc. So we did abandon the use of Kybella. And I know people still use it, but the original stuff, the PCDC, is still a vowel. It's made by a FDA approved PI with 3B manufacturer type of a compound. It is designed to be used both intravenous for breaking up soft plaques, but also could be used subcutaneous for killing off fat cells. So how is it working? Well, the deoxycholate portion of the PCDC is a bile salt and it directly emulsifies the fat wall. So fat cell gets destroyed, the lipids leak out and the cells go through what's called apoptosis or apoptosis, where the cell dies and it doesn't get replaced by another cell. So in many cases your cells will die programmed and another pre adipocyte or stem cell will replace it. In the case of destroying the fat cells, they don't get replaced. So the fat reduction is permanent. Now, you could always grow more fat tissue by expanding other fat cells, but in general, if your weight stays about the same, the reduction in fat will be permanent. It doesn't grow back. So they've experimented on an that right into other tissues like the skin or the muscle, and it still just destroy fat. It doesn't destroy skin or muscle. Now we can see damage to the skin in the case of pressure dressings. Many cases people are putting on compression because it feels better, but this can cause pressure sores. But in and of itself, it is very tolerant to the tissues and is selectively treating fat cells. The reduction in fat. Some people are concerned that they'll have saggy skin. We're not really seeing that. First off, there's a lot of inflammation that may cause some tightening. But when your weight fluctuates, if it's not a massive amount, the skin tracks the muscle in the fat, the skin tracks the size of the muscle in the fat. So we're not seeing saggy skin afterwards. We have tried it for cellulite, not working so good for that. We have used it for the abdomen, the flanks. Many different body parts can be used where there's subcutaneous fat. And the sweet spot seems to be the submental region of the neck. That's an area that, because it's not very big, we can get a really good target with the amount of medication we use. There is a limit to how much you can use. So somebody may say, I want to do my whole body. Well, you can only do about 1ccs of this medication at the strength we use it, which is about 12 and a half milligrams of deoxylate DC and 25 milligrams of phosphylcholine per milliliter. We can use about 120cc, which is enough to treat an area about this big. So I can like an abdomen or something like that. We do the neck, we might use more like 10 or 15ccs. The patient gets very red and swollen afterwards. It can look like an infection or a bee sting in terms of the discomfort. Sore, achy afterwards. And sometimes there's a little bit of firmness that lasts in the neck for a week or two, although you see the results pretty quickly, maybe in a week or so. And the final results are probably seen in about two months. So after the fat cells die, there's some cleaning up of the debris by your body, by your cleansing system, where, you know, that just gets reabsorbed. The tissues get reabsorbed and the skin retracts and the tissues regenerate. So we're seeing pretty consistent results. We've been doing this for 20 years at Allure, which one of the first doctors doing this. And so we've had a, you know, two decades of experience with it. The Kybella came out kind of promising to be a, you know, a brand name drug having one less component kind of a, I mean, technically probably a flop for Allergan to have done that. And this kind of led people to forget about the PCDC, which the Kybella was based on. So Kybella was an opportunity for a manufacturer to take advantage of a generic drug, change it a little bit to get a new patent on it, and come up with something in this case that was inferior. So the original version of lipidazole, this phosphatidylcholine deoxylate, there's a certain strength that we use, and we find that having twice as many milligrams of phosphatidylcholine or two to four times as much phosphylcholine as there is of the deoxycholate. There's much less inflammation, much less irritation, much less discomfort. You can use a higher dose of the deoxylate, which is the active ingredient at a given time, than the deoxylate alone, which really is a limitation, how much you can use because of inflammation and side effects. And this has been studied over the last 20 years. We have thorough information on it. When the Kybella came out, research on the PCDC kind of trickled off a little bit because now you got a major drug manufacturer supporting a new version, and that led to lack of interest. But then as the Kybella kind of didn't really turn out as promised, a lot of renewed interest in the phospho choline deoxycholate the original version came out. And now in the days of, you know, weight loss, with the Wegovy and Ozempic and Mangerna and Zeppbound, these GLP1 agonists, we're seeing people, you know, they're losing weight, but they still have troubling areas that they just can't get rid of. And maybe they don't want surgery, they don't want liposuction. So the lipo dissolve or pcdc, Lipo dissolve is a good alternative form. And again, you only treat an area about this big around at a given brain. So you might do your abdomen one week and do your flanks the next week, and then, you know, wait a month or two to see the results, see if you need to just do a second round. Typically, we're doing the neck. We're doing it one time and getting a good result. Some people do need more. If you did Kybella, it's average about six times. So we're not recommending Kybella. It's too expensive. The drug is way more expensive, way less effective. And the results are seen in two months for the final result. But you get a kind of have some downtime of redness and swelling for two, three days, maybe four or five days in some cases. So areas like in your waist, you can hide it pretty good, but you might not go to the gym because it's going to hurt. And jostling around your neck really can't hide it. You know, you put a mask on or something, it's kind of hard to hide it. So people might do this on a Friday and lay low Saturday and Sunday, and then on Monday, it's kind of hard to see you had anything done. And it's an alternative to liposuction. I mean, you use it in areas that you would perform liposuction. So subcutaneous fat and liposuction is something that we do, that we offer. But there's a lot of people, probably more people want to lose fat and not have liposuction. Then people want to lose fat and have liposuction. It is probably more cost effective to do PCDC in the neck than liposuction in the neck. Liposuction maybe gives us more, you know, tailored approach, but the results we're seeing with PCDC are pretty consistent. The images that you'll see are before and afters of just one treatment. Usually we're taking a picture afterwards, like two to five months after. That's when, you know, all the tissues are. The final results do occur. So Lipo dissolve is still an option. There's other options for non surgical fat loss besides weight loss, which would include freezing. Coolsculpting. We've done coolsculpting for 12, 13 years and you know, coolsculpting has worked pretty well. Never worked better than a lipo dissolve. But coolsculpting has no post procedure discomfort. It's more expensive, not quite as effective, but more post procedure discomfort. There's ways to use heat, there's some laser devices and radio frequency devices on the market, emsculpt and trusculpt and others that are effective. We've had different of those technologies as well and the three go tos we have would be pcdc, Lipo Dissolve, emsculptor, emsculpt, Neo and coolsculpting. But we have the most experience with the PCDC and it's kind of based on what we're trying to achieve. So the coolsculpting is for the person that doesn't want any shots and doesn't want the post procedure pain and understands it's more expensive, not quite as effective. The M sculpting is more for that person that wants to do some muscle building simultaneous with fat loss, which we don't see with coolsculpting or lipidissolve. And lipidissolve is a person who purely wants to have fat reduction in a targeted area. Much more targeted approach with lipo dissolve than any of the other technologies. So thank you very much.