A Shot to Melt the Fat?
The treatment sounds great, but it's unproven
Ross is seeking to get her money back. Jean Shepherd, fig.'s vice president of marketing, said in an E-mail that in such a situation, "the patient would be entitled to a refund and it would be processed in a timely manner." The company and the industry, she said, continue to study why some people don't respond to treatment.
One problem, says Bart Eastman, chief executive officer of AestheticMD, is that customers expect miracles when the technique produces subtle results. It can make a visible difference under the eyes and chin and in bra-line bulges, he says, but it won't remove as much fat as liposuction.
Pinpricks. The typical treatment consists of a series of injections that feel like pinpricks, given every two weeks in an average of six to eight visits. The substances supposedly destroy the fat cell wall, and the cell's contents are metabolized and excreted. Customers are told to expect mild bruising, soreness, and itching, which lasts a day or two, and some swelling, which can last up to three days. Any results can be expected to show up in several weeks, after the first two or three treatments. The fig. clinics charge $2,400 for one problem area, $4,000 for two areas, and $6,000 for three areas. LipoNOW charges $800 to $1,000 per area, and the MedSculpt patient typically pays $1,800 to $2,400.
Practitioners say that the fat-loss injections—which are sometimes referred to as mesotherapy—are less risky than liposuction because they're noninvasive and don't require anesthesia. With liposuction, "there's also the possibility that the cannula used to remove the fat will penetrate an organ," points out David Caplin, a plastic surgeon and the national medical director of fig. He says he's seen patients who have lost several inches around their hips, waist, and thighs after the injections and that recovery is quicker.
But the combined substance used in the injection isn't an approved drug. Although the individual ingredients are, like food, regulated for safety, they're not approved by the Food and Drug Administration to be injected for fat loss. But federal law allows pharmacists to compound chemicals into medications that are prescribed by doctors for individual patients. The most popular fatbusting mixture contains a combination of phosphatidylcholine (soy lecithin) and sodium deoxycholate (bile salt). Companies have their own proprietary formulas, so there can be variation in how the product is made.
"There's no uniform agreement among practitioners on what kinds of substances should be injected, in what concentrations, and in what combinations," says Alan Gold, president-elect of the ASAPS and a clinical associate professor of surgery at the Weill Medical College of Cornell University. What's more, he says, doctors who oversee the clinics may not administer the injections themselves but allow assistants, who may not be doctors, to do them. In May, Kansas began requiring physicians who administer lipodissolve to do an initial exam and write a prescription for the compound for each patient rather than ordering bulk quantities.
Even when clients can count on a good standard of practice, they have to go on faith that the injections actually work. Unlike liposuction, whose results can be stuck on a scale and weighed, lipodissolve's effectiveness is more subjectively measured as inches lost, weeks or months after treatment. Gold says that no one knows how much fat is shed or whether it winds up clogging other organs. A planned ASAPS-funded clinical trial comparing injections of phosphatidylcholine and sodium deoxycholate against placebo injections may yield some answers in the next year or two. The rate of side effects is unknown, too, but they include allergic reactions, skin ulcerations, scarring, and infections, according to Roxanne Guy, president of the American Society of Plastic Surgeons.
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