I’m seeing more and more “procedures� associated with dissolving fat: Zerona, Lipodissolve, and other fat injections. There are concerns about these procedures, and so I want to make sure that my patients understand why the controversy exists. Most physicians agree that many of these procedures do indeed dissolve fat away. The problem that many responsible doctors are concerned about is what happens to that fat once it dissolves?
Fat is held in fat cells, called adipose cells, and we see this fat as an accumulation of excess tissue in regions of the body that we don’t like- the abdomen, the hips, the love handles, etc… The fat dissolving procedures claim to melt away the fat deposits- further reading on the Zerona website states that “The laser causes the fat cell membrane to become temporarily porous, allowing the liquefied fat to leave the cell and accumulate in the interstitial space around the cells. There is no damage to the cell membrane and after 48 hours the pores close up. Once the fat is in the interstitial space, the body via the lymphatic system naturally removes it.� Similarly, the lipodissolve procedure is thought to dissolve the fat into the areas outside of the fat cells, the interstitial space, where it is taken away from the site of excess.
In each case, the question remains… where does the fat go? Thoughtful medical professionals are concerned that the fat may be brought to the liver, which acts as a filter for the blood and is a site of metabolism for much of the fat in our bodies. If this is so, the treated, “melted� fat might overwhelm the liver causing fatty liver or and significant liver disease or possibly liver failure. Another concern is that the fat could get picked up by the lymphatics or directly by the blood, and end up increasing deposits in the blood vessels themselves, worsening atherosclerosis and/or blockage of the coronary arteries. This might cause subsequent heart disease or heart attacks.
It must be understood how these procedures differ from liposuction. Remember that liposuction is a fat REMOVAL process, where the excess fat is removed from the body by the suction of the liposuction machine. Your physician can show you the collected fat in special canisters after your procedure if you like- it’s no longer in your body at all.
The significant questions and concerns with Lipodissolve and Zerona and similar fat dissolving procedures are principle reasons behind the fact that the Food and Drug Administration has not approved these types of procedures for the indications of cosmetic improvement of fat deposits. Until the understanding of the metabolism of the dissolved fat is better understood, it is thought to be an unknown with such severe possible side effects that it is not recommended.
My philosophy as a plastic surgeon in Santa Barbara is that while I want my patients to look great and feel fantastic about themselves, the health and safety of my patients comes before all else. Until I’m convinced of the science of the safety of the fat dissolving procedures, I am going to join my plastic surgery colleagues in recommending against this procedure. As always, when getting information about new and exciting procedures, it is vital that patients are well educated. I encourage all prospective plastic surgery patients in Santa Barbara and elsewhere to make sure your physician is a real plastic surgeon, and make sure that she or he is certified by the American Board of Plastic Surgery. See more on the importance of Board Certification here.