Circumscribed fat pads such as a double chin, hamster cheeks, sagging cheeks or fat pads on the inside of the knees or armpits cannot be influenced by training, a healthy diet or dieting. However, you can get rid of certain fat pads without surgical intervention. The so-called fat-away injection or injection lipolysis melts the excess fat to a certain extent. It is minimally invasive and complements the treatment spectrum of liposuction and tightening operations. However, this non-surgical treatment does not replace surgical liposuction (lipolysis).
This injection is the administration of different active substances to reduce disturbing fat deposits. In this method of aesthetic medicine, small amounts of substances are injected evenly under the skin into the areas of fatty tissue to be treated. This results in shrinkage and degradation of fat cells after several weeks. For this purpose, the application once is usually not enough, but usually must be repeated several times.
The costs (prices) of the treatment by fat-away injection depend on the size of the fat pads to be treated. According to the social courts, for the health insurance companies to cover the costs, there must be an "irregular body condition", "an impairment of function" and the "necessity of medical treatment". Therefore, patients usually bear the costs of injection lipolysis treatment themselves. You can get a guideline of the prices on our cost page. It should be taken into account that the treatment is usually not performed only once, but repeated three times in order to achieve the desired result.
The procedure of injection lipolysis is divided into several steps. The duration for the injection with the fat way syringe is about fifteen to thirty minutes. To optimize patient comfort, it is recommended to take 600mg of ibuprofen one hour before the treatment. An anesthetic cream may be applied three quarters of an hour prior. In rare cases, local anesthesia is required. Cooling the body surface five minutes before the treatment and immediately after the treatment additionally relieves pain and prevents bruising. The fat pad to be treated is outlined on the skin with a pen in consultation with you. The treatment is performed according to the strictest hygienic rules. Hand disinfection and disposable medical gloves prevent the spread of germs. Skin germs are killed by repeated application of a disinfectant. Very fine cannulas are used for the treatment. The preparation is injected at intervals of five to ten millimeters. When using the combination preparation (Lipostabil N®), 0.4 milliliters (twenty milligrams of phosphatidylcholine and ten milligrams of deoxycholic acid) are injected per puncture. When using deoxycholic acid alone (Kybella®) or Prostrolane, 0.2 milliliters (two milligrams of deoxycholic acid) is injected per puncture. The depth varies from six to ten millimeters depending on the region of the body. Treatment is repeated every four to six weeks. Three to five treatments are usually required to achieve the desired results. Protrolane Inner-B is injected up to four times per area at intervals of two weeks.
Filling contours of the neck under the chin can have various causes. In most cases, excess superficial fatty tissue is present. During the examination, we also look for other causes, such as swelling of the salivary gland, increased deep fat tissue, or a pronounced two-bellied muscle (musculus digastricus).
The Kybella® (deoxycholic acid) fat-away injection has been approved by the U.S. Food and Drug Administration (FDA) for the treatment of double chin. Lipostabil N® like fat way syringe is prepared by pharmacies according to tested regulations. Eighty-five to ninety percent of patients are very satisfied with Fat Away Injection after treatment of double chin (Beer K. et al, 2019, J Drugs Dermatol; Behr K. et al, 2019, Dermatol Surg). Examination and consideration of skin elasticity is critical for a good outcome. If excess skin is already present and shrinkage is unlikely, more appealing results can be achieved with a neck lift. Neck lift and liposuction usually leave inconspicuous scars.
After treatment of the double chin with injection lipolysis, there may be mild swelling, possible bruising, and minor pain. Three applications at intervals of four to six weeks should be expected for satisfactory results. Liposuction for double chin, on the other hand, does not need to be repeated. Liposuction can also treat the contours at the junction of the lower jaw. There is a risk of nerve damage when using the fat-routing injection on the lower jawline. There may be a distortion of the corner of the mouth, which is usually temporary. The skin incisions of liposuction are only a few millimeters short and can be easily hidden on the earlobe or under the chin.
Swelling, bruising, and mild pain occur after both the fat-blasting and liposuction procedures. Recovery varies from patient to patient after each appointment. Therefore, weighing whether the way fat injection or liposuction is the better solution is also an individual decision.
When using deoxycholic acid (Lipostabil N®), a tingling or burning sensation is occasionally experienced for a short time. The effect of lipolysis by injection is immediate. The body's own response to the destroyed fat tissue cells is immediate. In the first few days, this is manifested by a slight swelling. The cells are broken down over a period of six to eight weeks. The larger the area of the body, the more time passes before the final optimal result becomes apparent. If the treatment is repeated three times, the final result will be visible no later than six months after the first treatment.
Injection lipolysis leads to the death and reduction of small fat deposits. Unhealthy diet and little physical activity lead to an increase in body weight and girth measurements. Excess energy is stored in fat cells, which multiply and grow larger. In adulthood, however, the number of these remains constant. After the attending physician administers the injection, the contour of the treated region remains permanently diminished in relation to the rest of the body.
The Fat Away Injection is suitable for the treatment of mild to moderate fat deposits. With good skin elasticity, the skin usually shrinks in the following months. Injection lipolysis has no skin tightening effect.
The active ingredient in Lipostabil N® is phosphatidylcholine (five percent). Phosphatidylcholine was first described in the Soviet Union in 1959. Deoxycholic acid (2.5 percent) originally served to dissolve phophatidylcholine. Lipostabil® N is approved for the treatment of fat embolism. The use of Lipostabil N® substances for other purposes is referred to as "off-label use." "Off-label use" means that the use exceeds the intended approval. This means that liability of the pharmaceutical company is excluded.
The preparation was initially produced by the pharmaceutical company Nattermann. In 2006, Lipostabil® N became available on prescription. After several company takeovers, the last manufacturer MCM Klosterfrau stopped production in 2019. The drug can still be manufactured by certain pharmacies after prescription by a physician. The solution for injection is a clear, colorless, sterile liquid. The Lipostabil N® composition is equivalent to approximately fifty milligrams per milliliter of phosphatidylcholine and twenty-five milligrams per milliliter of deoxycholate (salt of deoxycholic acid).
Lipostabil N® was first used by Kroupa in 1966 to treat fat embolism. Maggiori first used Lipostabil N® in 1988 to treat fatty deposits under the skin (so-called xanthelasma). In 1995, the Brazilian Rittes injected Lipostabil N® to treat bags under the eyes. Because of the risk of skin breakdown, the Brazilian Ministry of Health banned the injection of Lipostabil® N for aesthetic purposes in 2011.
The active ingredient phosphatidylcholine is the most abundant phospholipid in nature. Phospholipids are fats with a water-soluble side and a water-repellent side. The envelope of every cell of every living thing (humans, animals, plants, and algae) is half phosphatidylcholine. Phosphatidylcholine helps metabolize cholesterol. Phosphatidylcholine aids in the digestion of fats and protects against gallstones and kidney stones. A preventive effect of phosphatidylcholine in Alzheimer's disease, vascular calcification and fatty liver is still being researched. We consume four to eight grams of phosphatidylcholine daily in our diet (e.g. egg yolk, soy products, milk, corn, cauliflower). Phosphatidylcholine leads to the release of blood fats and stimulates fat cells to release certain messenger substances (TNFα and IL-1β). These messengers initiate programmed cell death of fat cells. Phosphatidylcholine does not act on muscle cells, vessel wall cells (endothelial cells), and connective tissue cells (fibroblasts). The maximum dose of phosphatidylcholine per treatment is about 2500 milligrams.
Deoxycholic acid is a bile acid. Bile acids act like a solvent, by mixing fat and water. In the body, deoxycholic acid is produced by the liver and excreted through the bile ducts. Here, deoxycholic acid serves to digest fatty foods. In the tissues, deoxycholic acid leads to the breakdown of fat cells by so-called phagocytes (macrophages). It is assumed that deoxycholic acid destroys the envelopes of cells non-specifically. The death of cells by damage to the cell wall is also called necrosis. Muscle cells, connective tissue cells and nerve cells can also be damaged. Lipids from the cells are released. A localized inflammatory stimulus is produced. In response, connective tissue cells (fibroblasts) produce more collagen. No more than 100 milligrams of deoxycholic acid should be injected per treatment (Jones DH, et al., 2016, Dermatol Surg).
Prostrolane Inner-B contains sodium hyaluronate and protein complexes (nonapeptide-32, pentapeptide-43, tripeptide-41, octapeptide-11). Prostrolane Inner-B received approval as a medical device under ISO standard 10993-1 in 2018. As such, it is not subject to the much stricter Medicines Act. Prostrolane Inner-B is marketed for the treatment of fat bulges by South Korean company Caregen Co, LTD. The drug suppresses fat-building genes (PPARγ, ACC, and aP2) and activates fat-degrading genes (CPT1a, Acox, HSL, ATGL, PLIN1) and proteins (phospho-HSL, phospho-ATGL). Prostrolane Inner-B has not been subjected to a clinical trial under official supervision. There have been no scientific publications on efficacy or potential side effects as of the end of 2019.
Injection lipolysis can complement, but not replace, surgical removal of fat by suction. In the hands of an experienced plastic and aesthetic surgeon, treatment with a fat removal injection is safe. Its use is dangerous if there is insufficient knowledge of the anatomy, if alternative methods of treatment are not mastered and therefore not considered, or if the user is unable to treat any side effects or complications/adverse reactions that may occur.
Occasional side effects of the fat-weg injection (deoxycholic acid with or without phosphatidylcholine) include pain similar to sore muscles, redness, numbness and swelling in the treated area. These symptoms are limited to the injection site and usually subside after two to three days. After deoxycholic acid application (Kybella®), swelling and mild pain may last up to ten days. Injury to smallest blood vessels may result in hematomas. Cooling after the injection reduces the risk of bruising. Occasionally, indurations can be felt under the skin during the first weeks after treatment. The healing process is accompanied by tiny scars in the fatty tissue under the skin. These hardenings disappear after three to four weeks. Massage and compression garments support the regression of the hardening.
Superficial injection may cause damage to the treated areas. Administering too large a dose or injecting into poorly perfused or scarred tissue increases the risk of skin breakdown (also called necrosis). Transient hair loss on the neck is observed in seven percent of male patients. This is probably caused by superficial injection and damage to the hair roots.
Temporary nerve paralysis may occur during double chin treatment. In four percent of cases, weakness of muscles of the chin and corner of the mouth may occur hours to days after application in the lower part of the face. The lower lip may be temporarily distorted when laughing. The affected nerve usually recovers after three to six months. Swallowing disorders occur in two percent of cases after double chin treatment with deoxycholic acid (Kybella®). The dysphagia usually recedes after three days.
Severe allergic reactions (anaphylactic shock) following treatment with fat-away injection have not yet been described. People with a known allergy to soy or an allergy to benzyl alcohol should refrain from using a fat way injection. In case of doubt, an allergy test should be performed in advance.
- Aesthetic treatments are medical treatments.
- Cosmeticians or hairdressers violate Section 5 of the Heilpraktikergesetz if they perform aesthetic treatment.
- Every medical treatment requires information about the dangers of the treatment as well as about treatment alternatives. The duty to inform is to be fulfilled by the treating and sufficiently qualified physician. Clarification by non-medical personnel violates the German Civil Code Sections 630c Paragraph 2 S. 1, 630e Paragraph 1, Paragraph 2 S. 1 No. 1.
- The non-medical practitioner, unlike the specialist in aesthetic and plastic surgery, is not able to treat possible complications and side effects.
- Deoxycholic acid (Lipostabil N®) requires a prescription. Prescribing or dispensing prescription drugs by a non-medical practitioner is a violation of the Medicines Act Section 96, paragraph 15.
- As with any medical procedure, an interview and examination is first required to determine the exact findings. To make a medical diagnosis requires a medical degree and professional experience as a physician.
- Selecting the appropriate treatment requires extensive professional knowledge of equivalent indicated or common treatment alternatives. Scientific training and constant updating of knowledge are required for careful consideration of various medical treatment methods.
- A forward-looking treatment plan is a basic prerequisite for a good outcome. This requires an assessment of individual health risks and knowledge of preventive measures.
- The procedure requires a thorough knowledge of anatomy, cell interaction, tissue processes and metabolism. Experience in performing and managing complications and side effects is necessary.
- In order to obtain permission to work as a non-medical practitioner, it is sufficient to pass an examination at the responsible health office and to have a secondary school diploma. Training is absolutely voluntary. Neither the content of the training, the duration of the training nor the accreditation of the training centers is prescribed by law. For comparison: the path to becoming a specialist, an aesthetic plastic surgeon, begins with the admission procedure to medical school. The course of study at a university lasts at least six years and includes 5,500 hours of theoretical and practical instruction and three state examinations. This is followed by six years of practical training (11,600 hours) and an oral examination to obtain the specialist designation. The European Specialist designation also requires passing an oral and written examination.
Schedule a consultation with the specialist. Adherence to post-injection behavioral recommendations and overall health have a critical impact on complication rates. For example, cigarette smoking leads to more frequent wound healing disorders and inflammation. During a personal consultation, the specialized practitioner will address common questions, share more information with you, and analyze with you how many applications are recommended.
If pregnancy is likely, we strongly advise against treatment. The dangers of using lipolysis by injection during pregnancy are not known. There are no detectable changes in metabolism or blood levels (blood lipids, blood glucose, hormones such as insulin and leptin, liver levels, inflammatory markers such as interleukin 6 and C-reactive protein, white blood cells) after fat-away injection treatment (Lipostabil N®) (Reeds DN, et al. 2013, Aesthet Surg J). There are no reports of patients learning of their pregnancy after treatment. The risk of malformation cannot be ruled out by animal studies. Substances similar to the ingredient in Lipostabil N® or Kybella® (deoxycholic acid) are prescribed in tablet form (ursodeoxycholic acid) for the treatment of biliary obstruction. This treatment is also common for expectant mothers, as there is no fear of harmful effects on the unborn child.
Lipolysis by injection should not be used under the following circumstances:
- Scars or inflammation of the body site.
- If you have a bleeding tendency or are taking blood-thinning medication
- If you are pregnant
- In case of an allergy to soy or benzyl alcohol
- In case of health restrictions
The active ingredient in the Lipostabil N® or Kybella® fat-removal injection (deoxycholic acid) causes the fat cells to dissolve on the very day of treatment. After three days, white blood cells (neutrophils) and after seven days scavenger cells (macrophages) migrate into the tissue. They help to eliminate the remains of the dissolved fat cells. The immune system response, also called the inflammatory response, lasts two to four weeks. The redness and swelling in the area of the injection sites are external signs of it. An inflammatory process is accompanied by an increased demand for oxygen and nutrients and the release of neurotransmitters. Intense muscle training and cardio exercise also leads to the release of messenger substances and consumes oxygen as well as nutrients. Therefore, the healing phase of the small areas is affected by intense sports. Endurance or intense sports should be paused for two weeks. Relaxed exercise (50 to 60 percent of the maximum pulse rate) is possible a short time after treatment (after one day). However, the duration should not exceed thirty to sixty minutes per day in the initial phase.
The injection lipolysis procedure uses very fine 0.3 millimeter cannulas. Liposuction is performed with two to three millimeter fine cannulas. The cannulas used for liposuction enable treatment of the deeper layers of fat, while the fat-dissolving injection dissolves local fat deposits a few millimeters below the skin. Enclosed is a direct comparison of the two procedures:
|Fat Away Injection||Liposuction|
|For which cases is the application most suitable?||Small to medium fat pads.||Medium and large fat pads.|
|For which areas of the body is the application most suitable?||Double chin, hamster cheeks, sagging cheeks, inside of the knees, armpits.||Total body.|
|When will I be socially acceptable again?||Instantly.||After two to three days when treating medium fat deposits.|
|How many treatments are necessary?||Three.||One.|
|What is the result?||After four to six months.||After three months.|
|Are there scars after the treatment?||No.||Scarcely visible three to four millimeters small scars.|
|Is the treatment painful?||Mild pain up to one week.||Mild pain up to one week.|
|Which treatment is more financially beneficial?||Cost-effective for small fat deposits (two ampoules and three treatments).||Cost-effective for medium and large fat deposits (Patel S, et al., 2018, Facial Plast Surg).|
The finest needle of the fat-away injection is placed with millimeter precision. It works with pinpoint accuracy. Cryolipolysis achieves its effect by transferring cold to the fatty tissue. The currently smallest transfer instrument measures 2.5 x 7.5 centimeters. Both methods treat superficial fatty tissue. The following table compares both methods:
|Fat Away Injection||Cryolipolysis.|
|For which cases is the application most suitable?||Small to medium fat pads.||Small to medium fat pads.|
|For which areas of the body is the application most suitable?||Good delineated small areas: Double chin, hamster cheeks, sagging cheeks, inside of knees, armpits.||Larger areas: Abdomen, hips, thighs, back.|
|When will I be socially acceptable again?||Instantly.|
|How many treatments are necessary?||Three.|
|What is the result?||After four to six months.|
|Are scars visible after the treatment?||No.|
|Is the treatment painful?||Mild pain for up to one week.||Treatment may be slightly uncomfortable.|
|Which treatment is more economical financially?||Varies depending on the agent and size of the body sites.||Varies depending on the device and size of the body sites.|
The injection is best suited for targeted treatment of small excess fat deposits (up to 300 milliliters). In case of normal body weight and well-defined small fat pads, the method is particularly promising. Injection lipolysis can be used to correct contours after liposuction or after autologous fat treatment. Excess fat depot on the abdomen is usually best removed by liposuction, as there are several advantages. The results of liposuction on the abdomen can be seen more quickly. In addition, it is usually associated with lower costs in the abdominal region than injection lipolysis, which is repeated many times. To learn more, see our page on liposuction on the abdomen.
Before treatment with a lipolysis injection, the amounts of excess fat and excess skin must be carefully examined, especially in the area of the upper arms. Again, injection lipolysis is only suitable for removing small amounts of excess fat. Especially on the upper arms, very good skin elasticity is a prerequisite for a good result. Skin elasticity can be reduced by various factors: Skin aging from the age of 35, cigarette smoking, neglected sun protection, strong and frequent weight fluctuations. If the elasticity of the skin is reduced, fat removal injections or liposuction often do not achieve satisfactory results. In this case, an upper arm lift should be considered, as it offers several advantages. You can find out more about this on our upper arm lift page.
Bags under the eyes (called "festoons", "malar mounds" or "malar bags" in English) are caused by the sagging and bulging of the fat pad behind the eye ring muscle. The fat-away syringe reduces the protruding fat pad. Accompanying or alternatively, an accumulation of tissue fluid can lead to bags under the eyes (called "malar edema" in English). The tissue fluid is not removed by the fat-away syringe. We therefore examine in advance whether there is an accumulation of fluid or a fat deposit in the area of the bags under the eyes. Allergies and dysfunction of the heart, kidneys, liver or thyroid can lead to an accumulation of tissue fluid. Surgical correction is the treatment of first choice for pronounced and long-lasting bags under the eyes (Newberry et al., 2019, Aesthetic Surgery Journal). Slack ligaments or a slackened eye ring muscle are corrected by a lower eyelid lift. The tightening also removes excess skin from the lower eyelid.
Hamster cheeks on the face are caused by excess fat deposits on the cheeks. The superficial cheek fat and the buccal fat pad emphasize the contour of the face below the cheekbones. The nerves of the muscles of the eyelids and lips run below the superficial fat on the cheeks. An application of the fat-away injection on the cheek carries a high risk of injury to these nerves. A fat-away syringe is therefore not suitable for correcting hamster cheeks. The removal of the deep cheek fat plug as part of a cheek correction is a recognized procedure for correcting hamster cheeks. The procedure can be performed under local anesthesia and on an outpatient basis. Scars cannot be seen externally because they are removed through the oral mucosa. The superficial cheek fat can be partially removed with a gentle liposuction. In order to maintain harmonious proportions, the transition to the neck can also be treated with liposuction. It is accessed in a fold in front of the ear and leaves an inconspicuous scar.
The fat-away syringe is used in rare and selected cases to treat lipomas. Lipomas are benign tumors of adipose tissue. Lipomas change their size only minimally over the years. They feel soft and have a uniform structure. Lipomas can be easily distinguished from the surrounding fat tissue. Ultrasound or MRI examinations help determine the location and size of the fat tumor. Imaging procedures and the appearance of a surgical removal help distinguish benign and malignant tumors. Examination of the removed tissue under a microscope has the highest informative value when assessing fatty tumors. In the case of treatment with a fat-away injection, a supplementary examination of the tissue can be useful. The fat-away injection helps to shrink large but otherwise inconspicuous tumors. Removal of the lipoma after the treatment with the fat-away injection leaves a smaller scar. The removed lipoma is then examined under a microscope to remove any doubts.
In the United States, deoxycholic acid was approved for the treatment of the double chin by the United States Food and Drug Administration (FDA) in 2015. The preparation is sold under the name Kybella® by the Allergan company. Kybella® is also known under the name ATX-101 in drug studies. Kybella® is currently not approved in Germany. In 2019, the Federal Institute for Drugs and Medical Devices (BfArM) and the European Medicines Agency (EMA) warned of the risk of skin and tissue destruction (necrosis) when using Kybella®. A two milliliter Kybella® ampoule contains twenty milligrams of deoxycholic acid (ten milligrams per milliliter).
Some patients who have been treated at Centerplast in the past agree to share their experiences with interested parties. Talk to us about this in a personal consultation. You also have the opportunity to read reviews from patients about our practice and treatments on the Internet in advance. These are bundled on our testimonials page.