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    Injection lipolysis

    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).

    What is the fat-away injection?

    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.

    What is the cost of the Fat Away Injection?

    In our price calculator you have the possibility to find out the costs of an injection lipolysis treatment. Note: The price of a treatment with fat removal injections depends on the size of the fat pads to be treated. According to the social courts, in order for the health insurance funds to cover the costs, there must be an “abnormal physical condition”, the “necessity of medical treatment” and “functional impairment”. Therefore, patients usually bear the cost of injection lipolysis treatment themselves. You can get an idea of the prices on our cost page. It should be taken into account that the treatment is usually repeated not once, but three times to achieve the desired result.

    What can I expect during the treatment with the Fat Away Injection?

    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 a combination preparation, 0.4 milliliters (twenty milligrams of phosphatidylcholine and ten milligrams of deoxycholic acid) are injected per puncture. When using deoxycholic acid alone 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.

    Fat-away injection against double chin

    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 Fat Away Injection (deoxycholic acid) has been approved by the US Food and Drug Administration (FDA) for the treatment of double chin. There are other preparations that are similar to the fat-away injection and are prepared by pharmacies according to tested regulations. Eighty-five to ninety percent of patients are very satisfied with fat-away injections after double chin treatment [1]. 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 the treatment of the double chin by injection lipolysis, a slight swelling, possibly bruising and minor pain may occur. For a satisfactory result, three applications at intervals of four to six weeks should be assumed. Liposuction for double chin, on the other hand, does not need to be repeated. Liposuction can also treat the contours at the transition to the lower jaw. There is a risk of nerve damage when using the fat-routing syringe on the lower jawline. There may be a distortion of the corner of the mouth, which is usually temporary. The incisions of a liposuction are only a few millimeters short and can be easily hidden at the earlobe or theliposuction under the chin.

    Swelling, bruising, and mild pain occur after both the fat-routing injection and liposuction. Recovery after each appointment varies from patient to patient. Therefore, the decision as to whether liposuction or fat removal injections are the better solution is also an individual one.

    How quickly does the Fat Away Injection take effect?

    When using deoxycholic acid, 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.

    How long does the fat-away injection last?

    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.

    Does the Fat Away Injection result in skin tightening?

    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.

    What is the active ingredient in the Fat Away Injection?

    The active ingredient is phosphatidylcholine (five percent). Phosphatidylcholine was first described in 1959 in the Soviet Union. The deoxycholic acid (2.5 percent) originally served to dissolve the phophatidylcholine. The fat-away syringe is approved for the treatment of fat embolism. The use of their 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, it became available by 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. Its composition is equivalent to about fifty milligrams per milliliter of phosphatidylcholine and twenty-five milligrams per milliliter of deoxycholate (salt of deoxycholic acid). It was first used by Kroupa in 1966 to treat fat embolism. Maggiori used the preparation for the first time in 1988 for the treatment of fat deposits under the skin (so-called xanthelasma). In 1995, Brazilian Rittes injected the drug to treat bags under her eyes. Because of the risk of skin breakdown, the Brazilian Ministry of Health banned its injection for aesthetic purposes in 2011.

    What is phosphatidylcholine?

    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.

    What is deoxycholic acid?

    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).

    What is Prostrolane Inner-B?

    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 the ISO 10993-1 standard in 2018. It is therefore 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.

    Side effects of the fat removal injection

    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. Swelling and mild pain can last up to ten days after a deoxycholic acid application. 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. In two percent of the cases swallowing disorders occur after a double chin treatment with deoxycholic acid. The dysphagia usually recedes after three days.

    Allergic reactions to the fat-away syringe.

    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.

    10 reasons why the training of the practitioner is important in fat removal injections.

    • 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.
    • It’s prescription only. 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 an optimal result. For this purpose, it is necessary that the individual health risks are assessed by the specialist. In addition, the latter requires appropriate knowledge about preventive measures necessary to avoid complications or to prevent them if necessary. in case of emergency.
    • For the procedure, a precise knowledge of the anatomy is indispensable. The plastic surgeon must understand the complex interaction of the cells, the processes in the tissue and the metabolism in detail. Extensive experience in the implementation and treatment of possible 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.

    Fat Away Injection During Pregnancy

    If pregnancy is likely, we strongly advise against treatment. The dangers of using lipolysis by injection during pregnancy are not known. No changes in metabolism or blood levels are detectable after fat-away injection treatment (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) [2]. 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 of the fat-away injection 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.

    When should lipolysis by injection not be used?

    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

    Fat-away injection like no sport for a long time

    The active ingredient of the Fat Away Injection leads to the dissolution of the fat cells already on the day of the 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.

    Fat-away injection versus liposuction

    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:

    Fett-Weg-SpritzeFettabsaugung
    Für welche Fälle ist die Anwendung am besten geeignet?Kleine bis mittlere Fettpolster.Mittlere und große Fettpolster.
    Für welche Körperregionen ist die Anwendung besonders geeignet?Doppelkinn, Hamsterbäckchen, Hängebäckchen, Innenseite der Knie, Achseln.Gesamter Körper.
    Wann bin ich wieder gesellschaftsfähig?Sofort.Nach zwei bis drei Tagen bei der Behandlung mittlerer Fettpolster.
    Wie viele Behandlungen sind notwendig?Drei.Eine.
    Was ist das Ergebnis zu sehen?Nach vier bis sechs Monaten.Nach drei Monaten.
    Sind Narben nach der Behandlung zu sehen?Nein.Kaum sichtbare drei bis vier Millimeter kleine Narben.
    Ist die Behandlung schmerzhaft?Leichte Schmerzen bis zu eine Woche.Leichte Schmerzen bis zu eine Woche.
    Welche Behandlung ist finanziell günstiger?Kosteneffektiv bei kleinen Fettpolster (zwei Ampullen und drei Behandlungen).Kosteneffektiv bei mittleren und großen Fettpolster (Patel S, et al., 2018, Facial Plast Surg).

    Fat-away injection versus cryolipolysis

    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:

    Fett-Weg-SpritzeKryolipolyse
    Für welche Fälle ist die Anwendung am besten geeignet?Kleine bis mittlere Fettpolster.Kleine bis mittlere Fettpolster.
    Für welche Körperregionen ist die Anwendung besonders geeignet?Gut abgrenzbare kleine Stellen: Doppelkinn, Hamsterbäckchen, Hängebäckchen, Innenseite der Knie, Achseln.Größere Flächen: Bauch, Hüfte, Oberschenkel, Rücken.
    Wann bin ich wieder gesellschaftsfähig?Sofort.Sofort.
    Wie viele Behandlungen sind notwendig?Drei.Drei.
    Was ist das Ergebnis zu sehen?Nach vier bis sechs Monaten.Nach vier bis sechs Monaten.
    Sind Narben nach der Behandlung zu sehen?Nein.Nein.
    Ist die Behandlung schmerzhaft?Leichte Schmerzen bis zu eine Woche.Behandlung kann etwas unangenehm sein.
    Welche Behandlung ist finanziell günstiger?Variiert je nach Wirkstoff und Größe der Körperstellen.Variiert je nach Gerät und Größe der Körperstellen.

    Fat-away syringe on the abdomen

    The syringe is best suited for the targeted treatment of small excess fat deposits (up to 300 millilitres). This method is particularly promising for people with a normal body weight and well-defined small fat pads. Injection lipolysis can be used to correct contours after liposuction or after autologous fat treatment. An excess fat deposit on the abdomen is usually best removed by liposuction, as there are several benefits. The results of liposuction on the abdomen can be seen more quickly this way. In addition, it is usually associated with lower costs in the abdominal region than injection lipolysis, which is repeated many times. You can read more about this on our page about liposuction on the abdomen.

    Lipolysis injection for the upper arms

    Before treatment with a lipolysis injection, the amount 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 a very good skin elasticity is a prerequisite for a good result. Skin elasticity can be reduced by various factors: Aging of the skin from the age of 35, cigarette smoking, neglected sun protection, strong and frequent weight fluctuations. If the elasticity of the skin is reduced, a fat removal injection or liposuction often does not achieve a satisfactory result. In this case, an upper arm lift should be considered as it offers several advantages. You can read more about this on our upper arm lift page.

    Fat-away syringe against eye bags (malar bags)

    Tear sacs (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 way injection reduces the bulging 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 eliminated by the fat way injection. 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, as well as functional disorders of the heart, kidneys, liver or thyroid gland can lead to an accumulation of tissue fluid. For prominent and long-lasting bags under the eyes, surgical correction is the treatment of choice [3]. Sagging ligaments or a slack eye ring muscle are corrected by a lower eyelid lift. The tightening also eliminates excess skin of the lower eyelid.

    Fat-way syringe against hamster cheeks

    Hamster cheeks on the face are caused by excess fat deposits on the cheeks. The superficial cheek fat and the buccal fat pad accentuate the contour of the face below the cheekbone. Below the superficial fat of the cheeks run the nerves of the muscles of the eyelids and lips. An application of the fat way syringe on the cheek involves a high risk of injury to these nerves. A fat way injection is therefore not suitable for correcting hamster cheeks. The removal of the deep cheek fat plug as part of a cheek correction is considered an accepted procedure for the correction of hamster cheeks. The procedure can be performed under local anesthesia and on an outpatient basis. Scars are not visible externally, because the removal is done through the oral mucosa. The superficial cheek fat can be partially removed by gentle liposuction. To achieve harmonious proportions, the transition to the neck can also be treated with liposuction. The approach is made in a fold in front of the ear and leaves an inconspicuous scar.

    Fat-way syringe against lipomas

    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.

    What is deoxycholic acid?

    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 distributed by the company Allergan. It is also known as ATX-101 in drug studies and is currently not approved in Germany. In 2019, the German Federal Institute for Drugs and Medical Devices (BfArM) and the European Medicines Agency (EMA) warned of the risk of skin and tissue breakdown (necrosis) with its use. One ampoule of two milliliters contains twenty milligrams of deoxycholic acid (ten milligrams per milliliter).

    Experience reports on the fat-away-syringe

    Surely you have the desire to look at before and after pictures in advance. CenterPlast also offers this option. The pictures were taken with the consent of the patients and are of course anonymised. For more details on the topic, see the Before and After Pictures page.

    Field reports on the Fat Away Injection

    Some patients who have undergone treatment at Centerplast in the past are willing to share their experiences with interested parties. Talk to us about this in a personal consultation. Furthermore, you have the possibility to read reviews from patients about our practice and treatments on the internet in advance. These are bundled on our testimonials page.

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    The author

    Dr. Adelana Santos Stahl

    “Our goal is to provide the best, most discreet and precise treatment based on our extensive expertise in plastic surgery. „

    Dr. Adelana Santos Stahl is distinguished by a unique international perspective with a feminine view of plastic surgery. Her personalized and detailed approach is key to the beautiful and natural results she achieves. Having trained in Brazil, one of the largest and most well-known countries for aesthetic and reconstructive plastic surgery, she understands her patients’ desire to look and feel their best.She completed her medical studies and her training as a specialist for plastic and aesthetic surgery in Brazil. In 2009, she also successfully passed the German equivalence examinations for the medical state examination. Two years later, in 2011 she received the German and in 2012 the EU specialist recognition (EBOPRAS) for plastic surgery.From 2009 to 2013, she deepened her knowledge of aesthetic and reconstructive facial surgery with world-renowned representatives of plastic surgery such as Professor Gubisch at the Marienhospital and Madame Firmin in Paris.A VDÄPC Fellowship (continuing fellowship for graduate students) in Switzerland, France and the USA has further enriched her professional experience.Dr. Santos Stahl is active in several prestigious professional societies. Besides the DGPRÄC and DGBT, she is also a member of the Brazilian Society of Plastic Surgery – SBCP.She is also the author of several scientific articles and, together with her husband, is dedicated to research and clinical studies in the field of plastic surgery.

    References[+]

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