Mesotherapy, Lipotherapy and Kybella
Phosphatidylcholine (PCDC) is a form of Mesotherapy using subcutaneous injections, can be performed on any or all of the following: the sides of the abdomen, front of the abdomen, thighs, upper arm, chin, neck, infraorbital (fat pad below the eyes), buttock area, area between bra straps and underarms, above the knee.
Use of PCDC this way is an “off label” use and is not approved by the Federal Drug Administration (FDA). The field of Meso/Lipotherapy is continuing to evolve and hopefully will gain further awareness with the public.
The lastest development in this area is the recent FDA approval of PCDC in the form of the name brand Kybella. Many of our patients have heard of and asked for Kybella.
Kybella is a cosmetic treatment for the improvement in the appearance of submental fullness associated with submental fat in adults, also called “double chin”, and is approved by the FDA for this purpose. Although Kybella is also used for cosmetic treatment of other areas of the body, Kybella has not yet been approved by the FDA for that purpose. The results of Kybella are not immediate.
Kybella is injected into the fat under the chin. At the time of injection and for several days following the injections you will have swelling in the submental area. Kybella will cause the fat cells to diminish gradually over the course of the next month following your injection in the treated area. A series of treatments may be necessary to achieve optimal results and these will occur at no sooner than the one month interval. Dr. Mauer, in conjunction with the patient, will decide how many treatments are necessary. Kybella is intended to treat isolated submental fat; it has no effect on excess neck skin. After dissolving fat, any excess skin may be more prominent. There is a possibility of an unsatisfactory result from injections of Kybella. The procedure may result in unacceptable visible deformities or asymmetry in the treatment area.
The truth is that Kybella, sadly, is several magnitudes less potent than what was used for years before this name brand drug release. Kybella is also several magnitudes more expensive and limited to use for under the chin only.
This product is actually a wonderful aesthetic tool that may have health benefits and provide a less invasive alternative such as possible complications from surgery or the loose skin from traditional liposuction. The results in our experience are quite exceptional and we are definitely advantaged to now have a consensus that this is a safe medication for use.
Obviously years of experience and pioneering the use of the deoxycholic acid has made us leaders in the field. The ability to treat different parts of the body and use dosages differently that what’s available lets us do things that is not commonly seen.
The off label use of this medication has always been justified as a way of offering patients an alternative to surgery. In our practice, we have developed techniques through minimal puncture sites and the use of non needle injection techniques that have further increased patient’s satisfaction and decreased downtime and side effects from needles. Of particular importance is injection technique because the medication can leave marks in the skin if injected to superficially. Even though this medication can be used with any skin type, a too superficial injection in the skin can leave a permanent mark in a darker skin patient.
Of the concerns, swelling which is directly related to the amount of fat that is dissolved can be quite dramatic and in the stomach can temporarily look like a third trimester pregnancy. Pain and tenderness is possible. The branded drug does not allow mixing with any anesthetic and typically doctors inject lidocaine separately prior to the procedure. The drug also has a destructive effect on the fatty membrane covering nerve sheaths and numbness and temporary paralysis can occur when injected erroneously. Post procedural tenderness varies and pain, although not common, may be dependent on injection technique. Typically, with the compounded deoxycholic acid, additives such as lidocaine assist the tolerance and amplify the effects of the procedure.
This is where a customized tailored approach is always decided upon and how we decide to inject is individualized. Not every patient is an ideal candidate, just as not every injector is appropriate to use this tool. In the past, complications arose from inexperienced injectors using a powerful drug with poor skills. Apparently even with a grid and a diluted potency, the company has a released Kybella to only doctors who have been trained and approved by the company.
Post procedure patients can expect a degree of swelling based on the aggressiveness of the procedure itself. The fat is actually lysed in a process known as saponification. The deoxycholic acid acts as a detergent that disrupts the fat cell membrane and the contents are spilled into interstitial space. The pockets of destroyed fat can become hard and are cleaned up through the body’s lymphatic system. The process of inflammation, as well as a dispersion of fat stem cells, known as stromal vascular fraction are thought to be responsible for the skin repair and improvement in skin texture and tightening.
Today we are all familiar with fat destroying techniques using cold destruction, heat destruction via laser or high frequency ultrasound, and radio frequency. They all have some effect and are also alternative to surgical approaches. Similarly, they work on a small percentage of fat at each session but offer a non-invasive attempt at contouring the body. The advantage of deoxycholic acid the procedure is quicker and offers a less expensive option and an aesthetic benefit to the skin. The disadvantage is the slightly more invasive nature of injecting the substance and post operative swelling. Just like all these non-invasive approaches, and even liposuction, certain areas of the body respond better than others.
The new FDA approval of this drug seems to have opened up new interests and awareness of the possibility of treating lipodystrophy without surgery
As explained not all fat or fullness will respond to PCDC. Other alternative treatments are liposuction to the area, a neck lift and/or platysmoplasty procedures. Aside from these treatments, additional options for dermal soft-tissue augmentation include, but are not limited to, products such as Juvederm, Boletero, Expressions, Radiesse, Sculptra, Restylane, Perlane and your own fatty tissue. Other options not mentioned here may exist. All options should be discussed with Dr. Mauer.
We are conveniently located in the offices listed below
6 E 39th St. Suite 804a
New York, NY 10016
1512 Old Northern Blvd.
Roslyn, N.Y. 11576
8214 13th Avenue
Brooklyn, NY 11228
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You may also telephone us at: (212) 537-6836