Important information about the fat-away injection (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. Do you shy away from photos, whether professionally or privately? Do you suffer when you look in the mirror? Would you finally like to see yourself in pictures again? However, you can also get rid of certain fat deposits without surgery. The so-called fat removal 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).
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Information at a glance
Duration of treatment
30 minutes
Anesthesia
Anesthetic cream / vibration anesthesia
Hospitalization
Outpatient
Socially acceptable
immediately
Costs
Additions or alternatives
What is the fat-away injection and how much does it cost?
This injection involves the administration of various active ingredients to reduce unwanted fat deposits. In this method of aesthetic medicine, small amounts of substance are injected evenly under the skin into the areas of fatty tissue to be treated. Fat cells shrink and break down after several weeks. One application is not usually sufficient for this, but usually has to be repeated several times.
The price of a treatment with fat removal injections depends on the size of the fat deposits to be treated. According to the social courts, in order for health insurance companies to cover the costs, there must be an “abnormal physical condition”, the “need for medical treatment” and “functional impairment”. Patients therefore usually bear the costs of injection lipolysis treatment themselves. You can find a guide to the prices on our costs page. It should be borne in mind that the treatment is not usually carried out just once, but is repeated three times in order to achieve the desired result.
What can I expect from treatment with the fat-away injection?
The injection lipolysis procedure is divided into various steps. The duration of the injection with the fat-away injection is around fifteen to thirty minutes. To optimize patient comfort, it is recommended to take 600mg ibuprofen one hour before the treatment. An anesthetic cream can be applied three quarters of an hour beforehand. In rare cases, a local anesthetic is required. Cooling the body surface five minutes before the treatment and immediately after the treatment also relieves pain and prevents bruising. The fat pad to be treated is outlined on the skin with a pencil in consultation with you. The treatment is carried out in accordance with the strictest hygiene regulations. Hand disinfection and disposable medical gloves prevent the spread of germs. Skin germs are killed by repeated application of a disinfectant. The finest 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 injection. When using deoxycholic acid alone or Prostrolane, 0.2 milliliters (two milligrams of deoxycholic acid) are injected per injection. The depth varies from six to ten millimeters depending on the region of the body. The treatment is repeated every four to six weeks. As a rule, three to five treatments are required to achieve the desired result. Protrolane Inner-B is injected up to four times per area at two-week intervals.
Fat-away injection for a double chin
Full contours of the neck under the chin can have various causes. Excess superficial fatty tissue is usually present. During the examination, we also look for other causes, such as swelling of the salivary gland, increased deep fatty tissue or a pronounced two-bellied muscle (digastric muscle).
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 prepared by pharmacies according to tested instructions, similar to the fat-away injection. Eighty-five to ninety percent of patients are very satisfied with the fat-away injection after treatment of the double chin 1 . The examination and consideration of skin elasticity is crucial for a good result. If there is already excess skin and shrinkage of the skin 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 by injection lipolysis, 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 a double chin, on the other hand, does not need to be repeated. Liposuction can also be used to treat the contours at the transition to the lower jaw. There is a risk of nerve damage when using the fat removal syringe on the edge of the lower jaw. A distortion of the corner of the mouth may occur, which is usually temporary. The skin incisions forliposuction are only a few millimeters short and can be easily concealed on the earlobe or under the chin.
Swelling, bruising and slight pain occur after both fat removal injections and liposuction. Recovery after each appointment varies from patient to patient. Therefore, the decision as to whether fat removal injections or liposuction is the better solution is an individual one.
Active ingredient of the fat-away injection
The active ingredient is phosphatidylcholine (five percent). It was first described in the Soviet Union in 1959. Deoxycholic acid (2.5 percent) was originally used to dissolve phosphatidylcholine. The fat-away syringe is approved for the treatment of fat embolisms. 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 authorization. This means that liability on the part of the pharmaceutical company is excluded.
The preparation was initially produced by the pharmaceutical company Nattermann. It became available on prescription in 2006. After several company takeovers, the last manufacturer MCM Klosterfrau ceased production in 2019. The drug can still be produced by certain pharmacies after prescription by a doctor. The injection solution is a clear, colorless, sterile liquid. Its composition corresponds to approximately 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 for the treatment of fat embolism. Maggiori first used the preparation in 1988 to treat fat deposits under the skin (so-called xanthelasma). In 1995, the Brazilian Rittes injected the preparation to treat bags under the eyes. Due to the risk of skin breakdown, the Brazilian Ministry of Health banned its injection for aesthetic purposes in 2011.
Side effects of the fat-away injection
Injection lipolysis can supplement, but not replace, surgical removal of fat using liposuction. In the hands of an experienced specialist in plastic and aesthetic surgery, treatment with fat removal injections is safe. The application is dangerous if there is insufficient knowledge of the anatomy, if alternative treatment methods are not mastered and therefore not considered, or if the user is unable to treat any side effects or complications/side effects that may occur.
Occasional side effects of the fat-away injection (deoxycholic acid with or without phosphatidylcholine) are pain as with sore muscles, redness, numbness and swelling in the treated area. These symptoms are limited to the injection site and usually disappear after two to three days. Swelling and slight pain can last up to ten days after a deoxycholic acid application. Injury to the smallest blood vessels can lead to hematomas. Cooling after the injection reduces the risk of bruising. Occasionally, hardening can be felt under the skin in the first few weeks after treatment. The healing process is accompanied by tiny scars in the fatty tissue under the skin. These hardenings disappear again after three to four weeks. Massage and compression garments support the regression of the hardening.
Superficial injections can lead to 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 known as necrosis). Temporary hair loss on the neck is observed in seven percent of male patients. This is probably caused by a superficial injection and damage to the hair roots.
Temporary nerve paralysis can occur during the double chin treatment. In four percent of cases, the muscles of the chin and the corner of the mouth may become weak in the lower part of the face hours to days after application. The lower lip may be temporarily distorted when laughing. The affected nerve usually recovers after three to six months. In two percent of cases, swallowing disorders occur after double chin treatment with deoxycholic acid. The dysphagia usually disappears after three days.
Allergic reactions to the fat-away injection
Severe allergic reactions (anaphylactic shock) following treatment with a fat-away injection have not yet been described. People with a known soy allergy or an allergy to benzyl alcohol should refrain from fat-away injections. If in doubt, an allergy test should be carried out in advance.
10 reasons why the training of the practitioner is important for fat-away injections
- Aesthetic treatments are medical treatments.
- Cosmeticians or hairdressers are in breach of Section 5 of the Heilpraktikergesetz if they carry out an aesthetic treatment.
- Every medical treatment requires information about the risks of the treatment and about treatment alternatives. The duty to provide information must be fulfilled by the treating and sufficiently qualified doctor. Information provided by non-medical personnel violates the German Civil Code Sections 630c (2) sentence 1, 630e (1), (2) sentence 1 no. 1.
- In contrast to specialists in aesthetic and plastic surgery, alternative practitioners are not in a position to treat possible complications and side effects.
- It is only available on prescription. The prescribing or dispensing of prescription drugs by a non-medical practitioner is a violation of the Medicines Act, Section 96 (15).
- As before any medical procedure, a consultation and an examination are required to obtain a precise diagnosis. Making a medical diagnosis requires a medical degree and professional experience as a doctor.
- The selection of the appropriate treatment requires comprehensive specialist knowledge of equivalent indicated or usual treatment alternatives. This requires scientific training and continuous updating of specialist knowledge.
- A forward-looking treatment plan is a basic prerequisite for an optimal result. This requires the individual health risks to be assessed by a specialist. In addition, the patient requires appropriate knowledge of preventive measures in order to avoid complications or to prevent them if necessary. in the event of an emergency.
- Precise knowledge of the anatomy is essential for the procedure. The plastic surgeon must understand the complex interaction of the cells, the processes in the tissue and the metabolism in detail. Comprehensive experience in the implementation and treatment of any complications and side effects that may occur is necessary.
- To obtain a license to work as a non-medical practitioner, an examination at the relevant health authority and a secondary school leaving certificate are sufficient. Training is completely 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 at a university lasts at least six years and comprises 5,500 hours of theoretical and practical instruction as well as three state examinations. This is followed by six years of practical training (11,600 hours) and an oral examination to obtain the specialist title. In order to obtain the European specialist title, a written and oral examination must also be passed.
Arrange a consultation with the specialist. Adherence to the recommended behavioral measures after the injection and the general state of health have an immense influence on the complication rate. Cigarette smoking, for example, leads to more frequent wound healing disorders and is associated with inflammation. In a personal and individual consultation, the specialist will answer frequently asked questions, share further information with you and analyze together with you how many applications are recommended.
Fat-away injection versus liposuction and cryolipolysis
The injection lipolysis procedure uses the finest 0.3 millimeter cannulas. Liposuction is performed using two to three millimeter fine cannulas. The cannulas for suction allow the deeper layers of fat to be treated, while the fat-away injection dissolves local fat deposits just a few millimeters under the skin. Here is a direct comparison of the two methods:
| Fat-away injection |
Liposuction
| Cryolipolysis |
| Fat-away injection |
| Small to medium fat deposits. |
Liposuction
| Medium and large fat pads. |
| Cryolipolysis |
| Small to medium fat deposits. |
| Fat-away injection |
| Double chin, hamster cheeks, sagging cheeks, inside of the knees, armpits. |
Liposuction
| Entire body. |
| Cryolipolysis |
| Larger areas: Abdomen, hips, thighs, back. |
| Fat-away injection |
| Immediately. |
Liposuction
| After two to three days for the treatment of medium fat deposits. |
| Cryolipolysis |
| Immediately. |
| Fat-away injection |
| Three. |
Liposuction
| One. |
| Cryolipolysis |
| Three. |
| Fat-away injection |
| After four to six months. |
Liposuction
| After three months. |
| Cryolipolysis |
| After four to six months. |
| Fat-away injection |
| No. |
Liposuction
| Barely visible three to four millimeter scars. |
| Cryolipolysis |
| No. |
| Fat-away injection |
| Mild pain for up to a week. |
Liposuction
| Mild pain for up to a week. |
| Cryolipolysis |
| Treatment can be somewhat unpleasant. |
| Fat-away injection |
| Cost-effective for small fat deposits (two ampoules and three treatments). |
Liposuction
| Cost-effective for medium and large fat deposits [4] . |
| Cryolipolysis |
| Varies depending on the device and the size of the body parts. |
Body regions
Fat-away injection on the abdomen
The syringe is best suited for the targeted treatment of small excess fat deposits (up to 300 milliliters). The method is particularly promising for normal body weight and well-defined small fat deposits. Injection lipolysis can be used to correct contours after liposuction or autologous fat treatment. Excess fat deposits on the abdomen are usually best removed by liposuction, as there are several advantages. The results of abdominal liposuction can be seen more quickly. In addition, it is generally associated with lower costs in the abdominal region than repeated injection lipolysis. You can find out more on our page on liposuction on the abdomen.
Fat-away injection for the upper arms
Before treatment with a lipolysis injection, the amount of excess fat and excess skin, particularly in the upper arm area, must be carefully examined. Here too, injection lipolysis is only suitable for removing small amounts of excess fat. Particularly on the upper arms, very good skin elasticity is a prerequisite for a good result. Skin elasticity can be reduced by various factors: Skin ageing from the age of 35, cigarette smoke, neglected sun protection, strong and frequent weight fluctuations. If the skin’s elasticity is reduced, fat removal injections or liposuction are often unable to achieve a satisfactory result. An upper arm lift should be considered here, as it offers several advantages. You can find out more on our page on upper arm lifts.
Fat-away injection against bags under the eyes (malar bags)
Tear sacs (known as “festoons”, “malar mounds” or “malar bags”) are caused by the sagging and bulging of the fat pad behind the eye ring muscle. The fat removal injection reduces the bulging fat pad. Accompanying or alternatively, an accumulation of tissue fluid can lead to bags under the eyes (known as “malar edema”). The tissue fluid is not removed by the fat removal 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 functional disorders of the heart, kidneys, liver or thyroid gland can lead to an accumulation of tissue fluid. For pronounced and long-lasting bags under the eyes, surgical correction is the treatment of first choice 2 . Sagging ligaments or a sagging eye ring muscle are corrected by a lower eyelid lift. The tightening also removes excess skin from the lower eyelid.
Fat-away injection against hamster cheeks
Hamster cheeks on the face are caused by excess fat pads on the cheeks. The superficial cheek fat and the buccal fat pad emphasize the contour of the face below the cheekbone. The nerves of the muscles of the eyelids and lips run underneath the superficial cheek fat. Applying the fat removal syringe to the cheek carries a high risk of injury to these nerves. A fat removal injection 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 the correction of hamster cheeks. The procedure can be performed under local anesthesia and on an outpatient basis. Scars are not visible externally as the removal is carried out via the oral mucosa. The superficial fat in the cheeks can be partially removed by gentle liposuction. In order 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-away injection against lipomas
The fat injection is used in rare and selected cases for the treatment of lipomas. Lipomas are benign tumors of the fatty tissue. Lipomas change their size only minimally over the years. They are soft to the touch and have a uniform structure. Lipomas can be easily distinguished from the surrounding fatty tissue. Ultrasound or MRI examinations help to determine the location and size of the fatty tumor. Imaging procedures and visual inspection during surgical removal help to differentiate between benign and malignant tumors. Examination of the removed tissue under the microscope is the most informative way of assessing fatty tumors. A supplementary examination of the tissue may be useful during treatment with fat removal injections. The fat removal injection helps to reduce large but otherwise inconspicuous tumors. Removal of the lipoma after treatment with the fat removal injection leaves a smaller scar. The removed lipoma is then examined under a microscope to dispel any doubts.
Our before and after pictures of a treatment with the fat-away injection
You will no doubt wish to view before-and-after pictures in advance. CenterPlast also offers this option as part of a personal consultation. The pictures were taken with the consent of the patients and are of course anonymized.
FAQ – Frequently asked questions
When using deoxycholic acid, a tingling or burning sensation is occasionally felt 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 body region, the longer it takes to achieve the final optimal result. If the treatment is repeated three times, the final result will be visible at the latest six months after the first treatment.
Injection lipolysis leads to the death and reduction of small fat deposits. An unhealthy diet and little physical activity lead to an increase in body weight and girth. Excess energy is stored in fat cells, which multiply and become larger. In adulthood, however, the number of these remains constant. After the attending physician has administered the injection, the contour of the treated region remains permanently reduced in relation to the rest of the body.
The fat removal injection is suitable for treating mild to moderate fat deposits. With good skin elasticity, the skin usually shrinks over the following months. Injection lipolysis has no skin-tightening effect.
The active ingredient phosphatidylcholine is the most common phospholipid found in nature. Phospholipids are fats with a water-soluble and a water-repellent side. The envelope of every cell of every living organism (humans, animals, plants and algae) consists of half phosphatidylcholine. Phosphatidylcholine helps to metabolize cholesterol. Phosphatidylcholine supports the digestion of fats and protects against gallstones and kidney stones. The preventive effect of phosphatidylcholine on Alzheimer’s disease, vascular calcification and fatty liver is still being researched. We consume four to eight grams of phosphatidylcholine a day with our food (e.g. egg yolk, soy products, milk, corn, cauliflower). Phosphatidylcholine leads to the release of blood lipids and stimulates fat cells to release certain messenger substances (TNFα and IL-1β). These messenger substances initiate the programmed cell death of the fat cells. Phosphatidylcholine does not act on muscle cells, vascular 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 formed by the liver and excreted via the bile ducts. Here, deoxycholic acid is used to digest high-fat foods. In the tissue, deoxycholic acid leads to the breakdown of fat cells by so-called scavenger cells (macrophages). It is assumed that deoxycholic acid destroys the cell envelopes non-specifically. The death of cells due to damage to the cell wall is also known as necrosis. Muscle cells, connective tissue cells and nerve cells can also be damaged. The lipids from the cells are released. A localized inflammatory irritation occurs. Connective tissue cells (fibroblasts) then produce more collagen. No more than 100 milligrams of deoxycholic acid should be injected per treatment 3 .
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 in accordance with ISO standard 10993-1 in 2018. It is therefore not subject to the much stricter German Medicines Act. Prostrolane Inner-B is marketed by the South Korean company Caregen Co., LTD. for the treatment of fat pads. The preparation 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 clinical trials under official supervision. There were no scientific publications on efficacy or possible side effects by the end of 2019.
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 values are detectable after the fat-away injection treatment (blood lipids, blood sugar, hormones such as leptin, liver values, inflammation markers such as interleukin 6 and C-reactive protein, white blood cells). 4 . There are no reports of patients who found out they were pregnant after treatment. The risk of malformation cannot be ruled out by animal experiments. Substances similar to the ingredient in the fat-away injection are prescribed in tablet form (ursodeoxycholic acid) for the treatment of bile stasis. This treatment is also common for expectant mothers, as there is no risk of harmful effects on the unborn child.
Lipolysis by injection should not be used in the following circumstances:
- Scars or inflammation at the body site
- If you have a bleeding tendency or are taking blood-thinning medication
- In the event of pregnancy
- In case of an allergy to soy or benzyl alcohol
- In the event of health restrictions
The active ingredient in the fat removal injection dissolves the fat cells on the day of treatment. After three days, white blood cells (neutrophils) and after seven days macrophages migrate into the tissue. They help to remove the remains of the dissolved fat cells. The response of the immune system, also known as the inflammatory reaction, takes two to four weeks. The redness and swelling around the puncture sites are external signs of this. An inflammatory process is accompanied by an increased demand for oxygen and nutrients and the release of messenger substances. Intensive muscle training and cardio training also leads to the release of messenger substances and consumes oxygen and nutrients. The healing phase of the small areas is therefore impaired by intensive sport. Endurance or intensive sport should be stopped for two weeks. Relaxed movement (50 to 60 percent of the maximum pulse rate) is possible shortly after the treatment (after one day). However, the duration should not exceed thirty to sixty minutes per day in the initial phase.
The frequency of risks depends on the extent of the operation and the patient’s state of health. The type of anesthesia can also affect the risks. The safety of our patients is our top priority. We therefore use the gentlest form of anesthesia and ensure that the procedure is performed under the best possible conditions. A facelift is a safe procedure in the hands of an experienced specialist in aesthetic and plastic surgery. The overall risk of possible complications is around five percent [27]. There is an increased risk in overweight patients, smokers, in the combination of several operations, for example on the breast or abdomen, and in operations under general anesthesia. Possible risks include post-operative bleeding (two percent), inflammation (0.9 percent), accumulation of wound fluid (0.6 percent), wound healing disorders (0.6 percent) or nerve injuries (0.1 percent). The attending physician will of course provide you with comprehensive information on this.
AUTHOR
Dr. Adelana Santos Stahl
Our aim is to offer optimal, discreet and precise treatment based on our extensive expertise in the field of plastic surgery.
Dr. Adelana Santos Stahl has a unique international perspective with a female view of plastic surgery. Your individual and detailed approach is the key to the beautiful and natural results. Having trained in Brazil, one of the largest and best-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 training as a specialist in plastic and aesthetic surgery in Brazil. In 2009, she also successfully passed the German equivalence examinations for the state medical examination.
Two years later, in 2011, she received the German and in 2012 the EU specialist certification (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 scholarship for graduate students) in Switzerland, France and the USA has further enriched her professional experience. Dr. Santos Stahl is active in various renowned professional associations. In addition to 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.
She has been based in Saarbrücken since 2019.
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