Medical rehabilitation of complications after injections of lipolytics

Abstract

Lipolytic injections are widely used in cosmetology practice. In most cases, they are used to correct the contours of the body, as well as to reduce the amount of fat deposits in the submental area. Side effects after their use are rare and, as a rule, resolve themselves. However, in the case of the use of non-certified medications, the frequency and severity of complications increase sharply, which requires timely and highly qualified therapy.

The article presents overview data concerning the mechanism of action of the main types of lipolytics and their classification, indications and contraindications to lipolytic therapy, reveals the problems of complications that have developed as a result of their use. A description of a clinical case of the development of an inflammatory reaction after injection of a low-quality lipolytic in the area of paint fat bags is presented. The tactics of her therapy are described. This clinical case demonstrates the importance of using certified products, compliance with injection techniques and the correct choice of the patient for this method of cosmetic therapy.

The article is of interest to a wide range of specialists (cosmetologists, dermatovenerologists, plastic surgeons, physiotherapists).

Keywords

phosphatidylcholine / sodium deoxycholate / injectable lipolysis / lipolytics / complications of lipolytics

References

[1] Duncan DI, Palmer M. Fat reduction using phosphatidylcholine/sodium deoxycholate injections: Standard of practice. Aesthetic Plast Surg. 2008;32(6):858–872. doi: 10.1007/s00266-008-9188-9

[2] Duncan D.I., Palmer M. Fat reduction using phosphatidylcholine/sodium deoxycholate injections: Standard of practice // Aesthetic Plast Surg. 2008. Vol. 32, N 6. Р. 858–872. doi: 10.1007/s00266-008-9188-9

[3] Shirshakova MA. Mesotherapeutic correction of edematous-fibrous panniculopathy (cellulite) and local fat deposits. Plastic Sur Cosmetology. 2010;(3):445–449. (In Russ).

[4] Ширшакова М.А. Мезотерапевтическая коррекция эдематозно-фиброзной панникулопатии (целлюлита) и локальных жировых отложений // Пластическая хирургия и косметология. 2010. № 3. С. 445–449.

[5] Shirshakova MA. Mesotherapy of cellulite: some practical recommendations. Injection Methods Cosmetology. 2011;(2):26–29. (In Russ).

[6] Ширшакова М.А. Мезотерапия целлюлита: некоторые практические рекомендации // Инъекционные методы в косметологии. 2011. № 2. С. 26–29.

[7] Rotunda AM, Kolodney MS. Mesotherapy and phosphatidylcholine injections: Historical clarification and review. Dermatol Surg. 2006;32(4):465–480. doi: 10.1111/j.1524-4725.2006.32100

[8] Rotunda A.M., Kolodney M.S. Mesotherapy and phosphatidylcholine injections: Historical clarification and review // Dermatol Surg. 2006. Vol. 32, N 4. Р. 465–480. doi: 10.1111/j.1524-4725.2006.32100

[9] Lijnen P, Echevaria-Vazquez D, Petrov V. Influence of cholesterol-lowering on plasma membrane lipids and function. Methods Find Exp Clin Pharmacol. 1996;18(2):123–136.

[10] Lijnen P., Echevaria-Vazquez D., Petrov V. Influence of cholesterol-lowering on plasma membrane lipids and function // Methods Find Exp Clin Pharmacol. 1996. Vol. 18, N 2. Р. 123–136.

[11] Lieber CS, Robins SJ, Li J, et al. Phosphatidylcholine protects against fibrosis and cirrhosis in the baboon. Gastroenterology. 1994;106(1):152–159. doi: 10.1016/s0016-5085(94)95023-7

[12] Lieber C.S., Robins S.J., Li J., et al. Phosphatidylcholine protects against fibrosis and cirrhosis in the baboon // Gastroenterology. 1994. Vol. 106, N 1. Р. 152–159. doi: 10.1016/s0016-5085(94)95023-7

[13] Little A, Levy R, Chuaqui-Kidd P, Hand D. A double-blind, placebo-controlled trial of high-dose lecithin in Alzheimer’s disease. J Neurol Neurosurg Psychiatry. 1985;48(8):736–742. doi: 10.1136/jnnp.48.8.736

[14] Little A., Levy R., Chuaqui-Kidd P., Hand D. A double-blind, placebo-controlled trial of high-dose lecithin in Alzheimer’s disease // J Neurol Neurosurg Psychiatry. 1985. Vol. 48, N 8. Р. 736–742. doi: 10.1136/jnnp.48.8.736

[15] Cohen BM, Lipinski JF, Altesman RI. Lecithin in the treatment of mania: Double-blind, placebo-controlled trials. Am J Psychiatry. 1982;139(9):1162–1164. doi: 10.1176/ajp.139.9.1162

[16] Cohen B.M., Lipinski J.F., Altesman R.I. Lecithin in the treatment of mania: Double-blind, placebo-controlled trials // Am J Psychiatry. 1982. Vol. 139, N 9. Р. 1162–1164. doi: 10.1176/ajp.139.9.1162

[17] Bobkova VI, Lokshina LI, Korsunskii VN, Tananova GV. Metabolic effect of lipostabil-forte. Kardiologiia. 1989;29(10):57–60.

[18] Bobkova V.I., Lokshina L.I., Korsunskii V.N., Tananova G.V. Metabolic effect of lipostabil-forte // Kardiologiia. 1989. Vol. 29, N 10. Р. 57–60.

[19] Rittes PG, Rites C. Treatment of aging neck with Lipostabil Endovena. J Drugs Dermatol 2009;8(10):937–939.

[20] Rittes P.G., Rites C. Treatment of aging neck with Lipostabil Endovena // J Drugs Dermatol. 2009. Vol. 8, N 10. Р. 937–939.

[21] Heinrich KG. Efficacy of injections of phosphatidylcholine into fat deposits: A non-surgical alternative to liposuction in body-contouring. Indian Journal of Plastic Surgery. 2005;38(2):119–122. doi: 10.4103/0970-0358.19779

[22] Heinrich K.G. Efficacy of injections of phosphatidylcholine into fat deposits: A non-surgical alternative to liposuction in body-contouring // Indian J Plastic Sur. 2005. Vol. 38, N 2. Р. 119–122. doi: 10.4103/0970-0358.19779

[23] Hexsel D, Serra M, Mazzuco R, et al. Phosphatidylcholine in the treatment of localized fat. J Drugs Dermatol. 2003;2(5):511–518.

[24] Hexsel D., Serra M., Mazzuco R., et al. Phosphatidylcholine in the treatment of localized fat // J Drugs Dermatol. 2003. Vol. 2, N 5. Р. 511–518.

[25] Rittes PG. The lipodissolve technique: Clinical experience. Clin Plast Surg 2009;36(2):215–221. doi: 10.1016/j.cps.2008.11.003

[26] Rittes P.G. The lipodissolve technique: Clinical experience // Clin Plast Surg 2009. Vol. 36, N 2. Р. 215–221. doi: 10.1016/j.cps.2008.11.003

[27] Hasengschwandtner F. Injection lipolysis for effective reduction of localized fat in place of minor surgical lipoplasty. Aesthet Surg J 2006;26(2):125–130. doi: 10.1016/j.asj.2006.01.008

[28] Hasengschwandtner F. Injection lipolysis for effective reduction of localized fat in place of minor surgical lipoplasty // Aesthet Surg J. 2006. Vol. 26, N 2. Р. 125–130. doi: 10.1016/j.asj.2006.01.008

[29] Peckitt N. Evidence based practice: phosphatidylcholine. A review of evidence for the mode of action in injection lipolysis. Jeremy Mills Publishing: Yorkshire, UK; 2005. 154 p.

[30] Peckitt N. Evidence based practice: Phosphatidylcholine. A review of evidence for the mode of action in injection lipolysis. Jeremy Mills Publishing: Yorkshire, UK, 2005. 154 p.

[31] Duncan D, Rotunda AM. Injectable therapies for localized fat loss: State of the art. Clin Plast Surg. 2011;38(3):489–501. doi: 10.1016/j.cps.2011.02.005

[32] Duncan D., Rotunda A.M. Injectable therapies for localized fat loss: State of the art // Clin Plast Surg. 2011. Vol. 38, N 3. Р. 489–501. doi: 10.1016/j.cps.2011.02.005

[33] Rotunda AM, Suzuki H, Moy RL, Kolodney MS. Detergent effects of sodium deoxycholate are a major feature of an injectable phosphatidylcholine formulation used for localized fat dissolution. Dermatol Surg. 2004;30(7):1001–1008. doi: 10.1111/j.1524-4725.2004.30305

[34] Rotunda A.M., Suzuki H., Moy R.L., Kolodney M.S. Detergent effects of sodium deoxycholate are a major feature of an injectable phosphatidylcholine formulation used for localized fat dissolution // Dermatol Surg. 2004. Vol. 30, N 7. Р. 1001–1008. doi: 10.1111/j.1524-4725.2004.30305

[35] Hasengschwandtner F. Phosphatidylcholine treatment to induce lipolysis. J Cosmet Dermatol. 2005;4(4):308–313. doi: 10.1111/j.1473-2165.2005.00211

[36] Hasengschwandtner F. Phosphatidylcholine treatment to induce lipolysis // J Cosmet Dermatol. 2005. Vol. 4, N 4. Р. 308–313. doi: 10.1111/j.1473-2165.2005.00211

[37] Rose PT, Morgan M. Histological changes associated with mesotherapy for fat dissolution. J Cosmet Laser Ther. 2005;7(1):17–19. doi: 10.1080/14764170510037743

[38] Rose P.T., Morgan M. Histological changes associated with mesotherapy for fat dissolution // J Cosmet Laser Ther. 2005. Vol. 7, N 1. Р. 17–19. doi: 10.1080/14764170510037743

[39] Palumbo P, Melchiorre E, La Torre C, et al. Effects of phosphatidylcholine and sodium deoxycholate on human primary adipocytes and fresh human adipose tissue. Int J Immunopathol Pharmacol. 2010;23(2):481–489. doi: 10.1177/039463201002300210

[40] Palumbo P., Melchiorre E., La Torre C., et al. Effects of phosphatidylcholine and sodium deoxycholate on human primary adipocytes and fresh human adipose tissue // Int J Immunopathol Pharmacol. 2010. Vol. 23, N 2. Р. 481–489. doi: 10.1177/039463201002300210

[41] Duncan D, Rubin JP, Golitz L, et al. Refinement of technique in injection lipolysis based on scientific studies and clinical eva luation. Clin Plast Surg. 2009;36(2):195–209. doi: 10.1016/j.cps.2008.11.001

[42] Duncan D., Rubin J.P., Golitz L., et al. Refinement of technique in injection lipolysis based on scientific studies and clinical eva luation // Clin Plast Surg. 2009. Vol. 36, N 2. Р. 195–209. doi: 10.1016/j.cps.2008.11.001

[43] Salti G, Ghersetich I, Tantussi F, et al. Phosphatidylcholine and sodium deoxycholate in the treatment of localized fat: A double-blind, randomized study. Dermatol Surg. 2008;34(2):60–66; discussion 66. doi: 10.1111/j.1524-4725.2007.34009

[44] Salti G., Ghersetich I., Tantussi F., et al. Phosphatidylcholine and sodium deoxycholate in the treatment of localized fat: A double-blind, randomized study // Dermatol Surg. 2008. Vol. 34, N 2. Р. 60–66; discussion 66. doi: 10.1111/j.1524-4725.2007.34009

[45] Rotunda AM, Ablon G, Kolodney MS. Lipomas treated with subcutaneous deoxycholate injections. J Am Acad Dermatol. 2005;53(6):973–978. doi: 10.1016/j.jaad.2005.07.068

[46] Rotunda A.M., Ablon G., Kolodney M.S. Lipomas treated with subcutaneous deoxycholate injections // J Am Acad Dermatol. 2005. Vol. 53, N 6. Р. 973–978. doi: 10.1016/j.jaad.2005.07.068

[47] Yagima Odo ME, Cuce LC, Odo LM, Natrielli A. Action of sodium deoxycholate on subcutaneous human tissue: Local and syste mic effects. Dermatol Surg. 2007;33(2):178–188; discussion 88–89. doi: 10.1111/j.1524-4725.2006.33036

[48] Yagima Odo M.E., Cuce L.C., Odo L.M., Natrielli A. Action of sodium deoxycholate on subcutaneous human tissue: Local and systemic effects // Dermatol Surg. 2007. Vol. 33, N 2. Р. 178–188; discussion 88–89. doi: 10.1111/j.1524-4725.2006.33036

[49] American Society for Aesthetic Plastic Surgery [Internet]. National plastic surgery statistics: Cosmetic and reconstruction procedure trends. New York: American Society for Aesthetic Plastic Surgery. Available from: http://www.plasticsurgery.org/public_education/statistical_trends.cf. Accessed: 15.07.2022.

[50] American Society for Aesthetic Plastic Surgery [интернет]. National plastic surgery statistics: Cosmetic and reconstruction procedure trends. New York: American Society for Aesthetic Plastic Surgery. Режим доступа: http://www.plasticsurgery.org/public_education/statistical_trends.cf. Дата обращения: 15.07.2022.

[51] Vedamurthy M. Mesotherapy. Indian J Dermatol Venereol Leprol. 2007;73(1):60–62. doi: 10.4103/0378-6323.30661

[52] Vedamurthy M. Mesotherapy // Indian J Dermatol Venereol Leprol. 2007. Vol. 73, N 1. Р. 60–62. doi: 10.4103/0378-6323.30661

[53] Gupta A, Lobocki C, Singh S, et al. Actions and comparative efficacy of phosphatidylcholine formulation and isolated sodium deoxycholate for different cell types. Aesthetic Plast Surg. 2009;33(3):346–352. doi: 10.1007/s00266-008-9301-0

[54] Gupta A., Lobocki C., Singh S., et al. Actions and comparative efficacy of phosphatidylcholine formulation and isolated sodium deoxycholate for different cell types // Aesthetic Plast Surg. 2009. Vol. 33, N 3. Р. 346–352. doi: 10.1007/s00266-008-9301-0

[55] Duncan D, Hasengschwandtner F. Lipodissolve for subcutaneous fat reduction and skin retraction. Aesthetic Surgery Journal. 2005;25(5):530–543. doi: 10.1016/j.asj.2005.07.009

[56] Duncan D., Hasengschwandtner F. Lipodissolve for subcutaneous fat reduction and skin retraction // Aesthetic Surgery Journal. 2005. Vol. 25, N 5. Р. 530–543. doi: 10.1016/j.asj.2005.07.009

[57] El-Gowelli HM, El Sabaa B, Yosry E, El-Saghir H. Histopatholo gical and ultra-structural characterization of local neuromuscular damage induced by repeated phosphatidylcholine/deoxycholate injection. Exp Toxicol Pathol. 2016;68(1):39–46. doi: 10.1016/j.etp.2015.09.006

[58] El-Gowelli H.M., El Sabaa B., Yosry E., El-Saghir H. Histopatholo gical and ultra-structural characterization of local neuromuscular damage induced by repeated phosphatidylcholine/deoxycholate injection // Exp Toxicol Pathol. 2016. Vol. 68, N 1. Р. 39–46. doi: 10.1016/j.etp.2015.09.006

[59] Blandford AD, Ansari W, Young JM, et al. Deoxycholic acid and the marginal mandibular nerve: a cadaver study. Aesthetic Plast Surg. 2018;42(5):1394–1398. doi: 10.1007/s00266-018-1164-4

[60] Blandford A.D., Ansari W., Young J.M., et al. Deoxycholic acid and the marginal mandibular nerve: A cadaver study // Aesthetic Plast Surg. 2018. Vol. 42, N 5. Р. 1394–1398. doi: 10.1007/s00266-018-1164-4

[61] Sorenson E, Chesnut C. Marginal mandibular versus pseudo-marginal mandibular nerve injury with submandibular deoxycholic acid injection. Dermatol Surg. 2018;44(5):733–735. doi: 10.1097/DSS.0000000000001291

[62] Sorenson E., Chesnut C. Marginal mandibular versus pseudo-marginal mandibular nerve injury with submandibular deoxycholic acid injection // Dermatol Surg. 2018. Vol. 44, N 5. Р. 733–735. doi: 10.1097/DSS.0000000000001291

[63] Fagien S, Mcchesney P, Subramanian M, et al. Prevention and management of injection-related adverse effects in facial aesthetics: Considerations for ATX-101 (deoxycholic acid injection) treatment. Dermatol Surg. 2016;42(1):300–304. doi: 10.1097/DSS.0000000000000898

[64] Fagien S., Mcchesney P., Subramanian M., et al. Prevention and management of injection-related adverse effects in facial aesthetics: considerations for ATX-101 (deoxycholic acid injection) treatment // Dermatol Surg. 2016. Vol. 42, N 1. Р. 300–304. doi: 10.1097/DSS.0000000000000898

[65] Jones DH, Carruthers J, Joseph JH, et al. REFINE-1, a multicenter, randomized, double-blind, placebo-controlled, phase 3 trial with ATX-101, an injectable drug for submental fat reduction. Dermatol Surg. 2016;42(1):38–49. doi: 10.1097/DSS.0000000000000578

[66] Jones D.H., Carruthers J., Joseph J.H., et al. REFINE-1, a multicenter, randomized, double-blind, placebo-controlled, phase 3 trial with ATX-101, an injectable drug for submental fat reduction // Dermatol Surg. 2016. Vol. 42, N 1. Р. 38–49. doi: 10.1097/DSS.0000000000000578

[67] Souyoul S, Gioe O, Emerson A, Hoope D. Alopecia after injection of ATX-101 for reduction of submental fat. Сase Reports JAAD Case Rep. 2017;3(3):250–252. doi: 10.1016/j.jdcr.2017.02.021

[68] Souyoul S., Gioe O., Emerson A., Hoope D. Alopecia after injection of ATX-101 for reduction of submental fat // Сase Reports JAAD Case Rep. 2017. Vol. 3, N 3. Р. 250–252. doi: 10.1016/j.jdcr.2017.02.021

[69] Metzger KC, Crowley EL, Kadlubowska D, et al. Uncommon adverse effects of deoxycholic acid injection for submental fullness: Beyond the clinical trials. J Cutan Med Surg. 2020;24(6):619–624. doi: 10.1177/1203475420943270

[70] Metzger K.C., Crowley E.L., Kadlubowska D., et al. Uncommon adverse effects of deoxycholic acid injection for submental fullness: Beyond the clinical trials // J Cutan Med Surg. 2020. Vol. 24, N 6. Р. 619–624. doi: 10.1177/1203475420943270

[71] Prantl L, Gehmert S, Brébant V, et al. Lipolytic effects of nano particle sized polyenylphosphatidylcholine on adipose tissue: First promising in vitro and in vivo results. Hoesl Lin Hemorheol Microcirc. 2020;75(2):189–199. doi: 10.3233/CH-190715

[72] Prantl L., Gehmert S., Brébant V., et al. Lipolytic effects of nano particle sized polyenylphosphatidylcholine on adipose tissue: First promising in vitro and in vivo results // Hoesl Lin Hemorheol Microcirc. 2020. Vol. 75, N 2. Р. 189–199. doi: 10.3233/CH-190715

[73] Urbani CE. Urticarial reaction to ethylenediamine in aminophylline following mesotherapy. Contact Dermatitis. 1994;31(3):198–199. doi: 10.1111/j.1600-0536.1994.tb01975.x

[74] Urbani C.E. Urticarial reaction to ethylenediamine in aminophylline following mesotherapy // Contact Dermatitis. 1994. Vol. 31, N 3. Р. 198–199. doi: 10.1111/j.1600-0536.1994.tb01975.x

[75] Vikbjerg AF, Mu H, Xu X. Lipase-catalyzed acyl exchange of soybean phosphatidylcholine in n-Hexane: A critical evaluation of both acyl incorporation and product recovery. Biotechnol Prog. 2005;21(2):397–404. doi: 10.1021/bp049633y

[76] Vikbjerg A.F., Mu H., Xu X. Lipase-catalyzed acyl exchange of soybean phosphatidylcholine in n-Hexane: A critical evaluation of both acyl incorporation and product recovery // Biotechnol Prog. 2005. Vol. 21, N 2. Р. 397–404. doi: 10.1021/bp049633y

[77] Duncan DI, Chubaty R. Clinical safety data and standards of practice for injection lipolysis: A retrospective study. Aesthet Surg J. 2006;26(5):575–585. doi: 10.1016/j.asj.2006.08.006

[78] Duncan D.I., Chubaty R. Clinical safety data and standards of practice for injection lipolysis: A retrospective study // Aesthet Surg J. 2006. Vol. 26, N 5. Р. 575–585. doi: 10.1016/j.asj.2006.08.006

[79] Rosina P, Chieregalo C, Miccolis D, D'Onghia FS. Psoriasis and side-effects of mesotherapy. Int J Dermatol. 2001;40(9):581–583. doi: 10.1046/j.1365-4362.2001.01248-3.x

[80] Rosina P., Chieregalo C., Miccolis D., D'Onghia F.S. Psoriasis and side-effects of mesotherapy // Int J Dermatol. 2001. Vol. 40, N 9. Р. 581–583. doi: 10.1046/j.1365-4362.2001.01248-3.x

[81] Gokdemir G, Kucukunal A, Sakiz D. Cutaneous granulomatous reaction from mesotherapy. Dermatol Surg. 2009;35(2):291–293. doi: 10.1111/j.1524-4725.2008.01053.x

[82] Gokdemir G., Kucukunal A., Sakiz D. Cutaneous granulomatous reaction from mesotherapy // Dermatol Surg. 2009. Vol. 35, N 2. Р. 291–293. doi: 10.1111/j.1524-4725.2008.01053.x

[83] Davis MD, Wright TI, Shehan JM. A complication of mesotherapy: Noninfectious granulomatous panniculitis. Arch Dermatol. 2008;144(6):808–809. doi: 10.1001/archderm.144.6.808

[84] Davis M.D., Wright T.I., Shehan J.M. A complication of mesotherapy: Noninfectious granulomatous panniculitis // Arch Dermatol. 2008. Vol. 144, N 6. Р. 808–809. doi: 10.1001/archderm.144.6.808

[85] Tan J, Rao B. Mesotherapy-induced panniculitis treated with dapsone: Case report and review of reported adverse effects of mesotherapy. J Cutan Med Surg. 2006;10(2):92–95. doi: 10.2310/7750.2006.00013

[86] Tan J., Rao B. Mesotherapy-induced panniculitis treated with dapsone: Case report and review of reported adverse effects of mesotherapy // J Cutan Med Surg. 2006. Vol. 10, N 2. Р. 92–95. doi: 10.2310/7750.2006.00013

[87] Kutlubay Z, Gokalp H, Ince U, Engin B. Cutaneous foreign body granulomas associated with lipolytic cocktail: Who is the ene my, mesotherapy or drugs injected? J Cosmet Laser Ther. 2017;19(5):310–312. doi: 10.1080/14764172.2017.1303167

[88] Kutlubay Z., Gokalp H., Ince U., Engin B. Cutaneous foreign body granulomas associated with lipolytic cocktail: Who is the enemy, mesotherapy or drugs injected? // J Cosmet Laser Ther. 2017. Vol. 19, N 5. Р. 310–312. doi: 10.1080/14764172.2017.1303167

RIGHTS & PERMISSIONS

Eco-Vector