LipoDissolve Injections For the Treatment of Lipomas

LipoDissolve, or the introduction of a chemical formulation by injection to treat spot areas of undesired fat for cosmetic purposes, remains a controversial and non-FDA approved procedure at this point in time. Despite these issues, I have found in the past 3 years in my practice a role for LipoDissolve if it is used judiciously and with good patient selection. I have not experienced any of the complications or problems that I have read about on the internet and I suspect that rigid patient selection, keeping the injections less than 100 per session, and good sterile technique are the reasons why. One application that I have found LipoDissolve injections particularly useful is in the treatment of lipomas.

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Lipomas are fatty tumors that can appear anywhere on the body from the scalp to the legs. They are soft, easily moveable (non-adherent) masses beneath the skin that are always round in diameter. They are usually right under the skin and are very slow growing. Most patients seen usually just have one in isolation. There are, however, some patients who have a familial lipomatosis syndrome in which they develop many lipomas throughout their body continously over their lifetime. Lipomas are traditionally treated by excision which removes them in their entirety, establishes their pathology by visual and microscopic examination (if sent to a pathologist) and leaves a residual scar. In some locations, and at the desire of some patients, a scar is not wanted nor is any type of surgical procedure if possible. LipoDissolve offers a non-surgical alternative to traditional excision for some lipomas. If the excision will leave a scar over a prominent area (e.g., the shoulder of a woman) and you are fairly certain that the mass is a lipoma by examination and history, then injection treatment are an option.

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I have found that full-strength LipoDissolve injections can work quite well in the nearly 15 lipomas that I have treated thus far in the past two years. The concept is that it is a series of injections, spaced four to six weeks apart, to either reduce the size of the lipoma or completely remove it. In the nine patients (14 lipomas) that I have treated, the average number of injection sessions is nearly 5 (4.8) per patient. This does not take into account that the largest of the lipomas that I have treated (14 x 10 cms) took eight injection sessions while very small ones (2 x 2 cms) may take only one or two injections. Patients will experience a large amount of swelling for the first week and some discomfort which is typical but not lifestyle-limiting.

Since lipomas represent a concentrated nucleus of fat, it is not surprising that LipoDissolve injections can be effective. Its use, however, is not as efficient as surgery (and insurance does not cover the procedure) but it does save a scar and, in large lipomas, the risk of a fluid build-up after surgery or the need for postoperative drains. Before treatment, one has to be fairly certain that the mass is indeed a lipoma. An MRI may be done if necessary to establish the diagnosis in larger lipomas. I have not yet seen a recurrence in any lipomas that I have treated but it is too early to be absolutely certain of that in my present patient series.

LipoDissolve Injections For the Treatment of Lipomas

Dr Barry Eppley, board-certified plastic surgeon of Indianapolis, operates a private practice at Clarian North and West Medical Centers in suburban Indianapolis. He writes a daily blogs on topics and trends in plastic surgery at http://www.exploreplasticsurgery.com

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Reconstruction of Breast Lumpectomy Defects With Fat and Stem Cell Injections

Lumpectomies for the treatment of breast cancer is an increasing method of therapy that spares much of the breast. With earlier detection of breast cancer today, less invasive and better breast conservation is now commonplace. Lumpectomies, however, leave indentations and crater-like dents after the cancerous tissue has been removed. Because of the size and location of lumpectomy defects, the traditional use of breast implants for reconstruction may not always result in a satisfactory solution. Other autologous methods of breast reconstruction such as muscle and skin-fat flaps may be too big of an operation for the problem with donor scars that are undesired.

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Recent work around the world has led to a new and less invasive method of breast reconstruction for lumpectomy defects. Provided adequate breast skin is present, filling the space where the breast tissue was removed can restore areas of indentations and collapse. Using cosmetic liposuction techniques, fat cells are harvested , stem cells extracted from the fat, and a combination of stem cells and purified fat is injected into the breast defect.

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This innovative, but not completely proven, treatment is based on the awareness that subcutaneous fat is a rich source of stem cells. Stems cells are pluripotent cells that can be theoretically stimulated to turn into new fat cells. (perhaps this is what happens from crash dieting and then rebound weight gain?) Fat is suctioned, usually from the abdomen or hips, and the stem cells are then isolated through a centrifugation method. The extracted stem cells are then mixed in with the remaining fat and injected it into the breast lumpectomy defect.site. The hope is that the use of stem cells will help keep the transplanted fat alive...or become fat cells themselves. Either way, the volume of injected material remains because it becomes living tissue.

The American Society of Plastic Surgery has issued a specific position paper on the use of injected fat into the breast. In summary, they state the its use and the final results are affected by a lot of different factors, particularly the technique used to harvest, concentrate, mix, and ultimately inject into the breast. The procedure is highly operator dependent. It use in the breast is lacking sufficient scientific studies to determine long-term effectiveness. The decision to use fat injections in the breast is one to be decided between patient and their plastic surgeon.

The use of fat injections, with or without stem cells, has a lot of use and recent history for facial and buttock augmentation. In my Indianapolis plastic surgery practice, my experience with stem cell concentrates is limited but I have often used platelet-rich plasma (PRP) with fat to enhance survival. The combination of cleaned and purified fat, stem cells, and PRP would be the ultimate therapeutic cocktail. This may be a bit of an alchemist's approach, but all the components are autologous and would cause no harm. The goal is how to optimize fat graft survival and maintain volume. I am confident that both PRP and stem cell additions are useful but the question is which one of the two is better. At present, this is unknown. I am beginning a clinical trial in the near future to look at these very issues and how this approach works for breast lumpectomy defects.

Reconstruction of Breast Lumpectomy Defects With Fat and Stem Cell Injections

Dr Barry Eppley is a board-certified premiere plastic surgeon in private practice in Indianapolis, Indiana at Clarian Health Systems. (http://www.eppleyplasticsurgery.com) He writes a daily blog on plastic surgery, spa therapies, and medical skin care at http://www.exploreplasticsurgery.com Dr. Eppley can be heard on his weekly radio show, Doc Chat, on WXNT 1430AM Indianapolis on Saturday afternoons.

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Muscle Weakening Injections - The Bruxism Cure

Bruxism is a common orofacial problem, which affects a large number of people all around the world. It presents as chronic teeth clenching, grinding, and temporal headaches. While not yet widely recognized or employed by most dentists, bruxism can be successfully with Botox injections.

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I have found Botox to be tremendously effective at masseter muscle hypertrophy and symptomatic teeth clenching. Bruxism or chronic grinding of teeth can cause the jaw muscles to become stronger and achieve a square shape, while simultaneously causing damage to the back premolar and molar teeth.While dental splints and appliances are the standard of care currently, they do not treat the source of the problem (muscle) but rather are primarily protective of ongoing damage to the teeth. Conversely, Botox achieves muscle relaxation or stops muscle spasm which are triggered by the muscles of the jaw.

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The part of the masseter muscle that is injected is the lower part which is easy to feel bulging when one clenches. This is in front of the parotid gland and above where the marginal mandibular nerve passes along the lower jawline. It is essentially at the jaw angle area. While other parts of the masseter muscle can be injected, this lower area is the easiest with essentially no risk of any complications. By using a very small 30 gauge long needle and a 1cc syringe, Botox can be near painlessly injected in multiple areas of the bulging muscle.

Many people have a symptomatic facial side, and often that side is visibly larger than the non-or less symptomatic side. In these patients, I will inject only the larger side with about 25 units. When both sides are involved, I will put more on the larger side. On average, it takes about 25 units per side injected into the thickest and most protruding masseter muscle. (when the patient clenches) At a cost of around to per unit, cost estimates per side would be about 0. Botox will not work immediately, on average it takes 3 to 5 days to begin working.

Most patients that I have treated get significant relief with Botox injections. For some, it is a complete 'cure' (albeit temporary) and for others it is about reduction in their symptoms. I have yet to see a a patient who gets no relief with an identified large masseter muscle bulging. Pain and clenching relief will last around 4 months which is typical for how long Botox lasts in the face for expression reduction. Interestingly, one will usually see the size of the muscle reduce over time, often within the first treatment cycle. While not fully explained, this muscle shrinking is seen consistently.

How long does one need Botox for clenching symptom relief? That is going to vary per each patient. Some may only need one or two treatments and then the cycle is broken. Others may need consistent treatment every 4 months for a year or two. It is not possible to predict for anyone how long one may need or want this injection therapy.

Muscle Weakening Injections - The Bruxism Cure

Dr Barry Eppley is a board-certified premiere plastic surgeon in private practice in Indianapolis, Indiana at Clarian Health Systems. (http://www.eppleyplasticsurgery.com) He writes a daily blog on plastic surgery, spa therapies, and medical skin care at http://www.exploreplasticsurgery.com Dr. Eppley can be heard on his weekly radio show, Doc Chat, on WXNT 1430AM Indianapolis on Saturday afternoons.

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